Massive transfusion practices and low-titer group O whole blood utilization before and after implementation in a low-volume level I trauma center: A six-year review.

BACKGROUND

Low-titer O whole blood (LTOWB) has been increasingly incorporated into trauma resuscitation and massive transfusion protocols (MTPs). Recent randomized trials have not demonstrated superiority of prehospital LTOWB over component-based resuscitation, while the utilization and sustainability of LTOWB programs, particularly in low-volume trauma systems, remain incompletely characterized.

STUDY DESIGN AND

METHODS

This was a 6-year review (April 2019-April 2025) of trauma MTPs at a level 1 trauma center with a low MTP frequency. Transfusion service logs, trauma flowsheets, prehospital and electronic medical records were reviewed for product usage, LTOWB utilization and discard patterns, and clinical outcomes.

RESULTS

One hundred and twenty-five MTPs were identified (122 component-only and 11 LTOWB-supported), with predominantly male (70%) and 81% blunt trauma. Component MTPs had a median RBC utilization of 6 units; 45% required ≤1 MTP line. Prehospital LTOWB use was limited: 33% of units were transfused, and only 2 of 13 patients requiring an MTP received prehospital LTOWB. LTOWB-supported MTPs typically issued 10 units, and most patients received 1-2 units. Of 524 LTOWB units procured during the first 6 months, 201 were transfused and 323 discarded (62%), with a peak discard rate of 81% early in rollout. Overall, 30-day mortality was 54%, and 25% occurred within 4 h.

CONCLUSIONS

LTOWB use was limited, and early wastage was substantial. LTOWB implementation in low-volume centers should align inventory and protocols with clinical demand; stewardship measures may reduce waste and improve sustainability.