Blood management practices during rapid transfer of urgent trauma patients pre- and post-implementation of ROTEM (R)-guided transfusion

Objective The 'Red Blanket' protocol fast tracks trauma patients with severe blood loss to the designated trauma operating theatre directly from the hospital helipad or Emergency Department. This study aimed to assess the impact of patient blood management (PBM) strategies on severely injured trauma patients treated under the 'Red Blanket' protocol at a quaternary referral hospital. Methods This retrospective review was conducted on all urgent trauma cases that were treated under the 'Red Blanket' protocol in a ten-year period between January 2007 and December 2017. The use of blood products and patient outcomes was compared between the 3.5-year periods pre- and post-ROTEM (R) implementation on 30th June 2014 (Jan 2011-June 2014 versus July 2014-Dec 2017). Results During the study period, 120 trauma patients were treated under the 'Red Blanket' protocol at our institution. Intention to treat analysis showed a reduction in fresh frozen plasma usage following the introduction of ROTEM (R)-guided transfusion. Furthermore, subgroup analysis suggested reduced blood product usage in patients who survived. Conclusions Patient blood management is a coordinated package of systems and tools, including education, patient logistics, anaemia management, intraoperative cell salvage, rotational thromboelastometry and massive transfusion protocols that together conserve blood products and improve outcomes. The implementation of ROTEM (R)-guided transfusion demonstrated a reduction in fresh frozen plasma usage.