AABB 2018 Boston Abstract from UCSD
https://aabb.confex.com/aabb/2018/meetingapp.cgi/Paper/4719
Background/Case Studies: During a massive transfusion event, the time required to issue large quantities of blood products and transport them to the patient can be problematic; clinicians often stockpile blood products at the bedside for better availability. Prompted by moving to a new building in which the blood bank was far from the operating room, we implemented the use of Hemoroam 15XL mobile blood storage refrigerators (MBRs) (Roemer Industries, Santee, CA) at our university health system, which includes 2 hospitals, a Level I trauma center, an obstetrics service and a liver transplant service (750 inpatient beds, transfusion volume: 23,000 red cell units annually). Our new massive transfusion protocol (MTP) utilizes a rotation of 3 MBRs to keep blood products continuously available at the bedside.
Study Design/Method: Approval and funding were obtained from the hospital administration, and 10 MBRs were purchased and validated. A new standard operating procedure (SOP) for the MBR was implemented, and our blood issuing SOP was updated. Previously, our issue process involved a courier reading the product information to a technologist. In the new process, one technologist issues products in the computer system, and a second technologist checks the products in the MBR against the printed report. The first MBR is stocked with 10 units of red cells and 10 plasma. A room-temperature drawer contains 1 apheresis platelet and if ordered, cryoprecipitate. When the first MBR is issued, a second is prepared. After the second MBR is issued, a third is prepared. The third MBR is issued upon the return of the first, and the cycle can continue as long as the MTP is active. The MBRs were piloted with the liver transplant program, and usage was subsequently expanded to the entire health system, including MTPs and other high-volume transfusion events upon request. Issuing time and usage trends were evaluated.
Results/Finding: The new MBR system has been used 207 times at our institution between August 2017 and March 2018. Of these, 61 (28%) were for massive transfusions (28 for liver transplants, 10 for trauma, 23 for other non-trauma, including obstetrics and critical care). Evaluation demonstrated minimum usage in October (0.16 protocols per day) and a maximum in January (0.39 protocols per day), with an overall average of 0.27 protocols per day. The time to issue 10 blood products using the old SOP was 8 minutes (48 seconds/unit) while issuing time using the new SOP is 7.1 minutes (42.6 seconds/unit, 11% decrease).
Conclusion: Rotating 3 MBRs during an MTP event facilitates a constant supply of blood at the patient’s bedside and decreases blood issuing time. Clinicians have embraced this strategy and the transfusion service has received positive feedback.
Authors
Wesley Rubenstein, DO University of California San Diego
Aaron J. Harding University of California San Diego
Patricia Kopko, M.D University of California San Diego
Elizabeth S. Allen, MD University of California San Diego
Lilia Mejia University of California San Diego
