J Trauma Acute Care Surg. 2019 Aug 5;Epub ahead of print

# A Novel Protocol to Maintain Continuous Access to Thawed Plasma at a Rural Trauma Center.

Hannigan C, Ologun G, Trecartin A, Colom L, Bloomdahl R, Seyer A, LaRock L, Tubby B, Cagir B, Granet J, Behm R.

BACKGROUND: Early administration of plasma improves mortality in massively transfused patients, but the thawing process causes delay. Small rural centers have been reluctant to maintain thawed plasma due to waste concerns. Our 254-bed rural level II trauma center initiated a protocol allowing continuous access to thawed plasma and we hypothesized its implementation would not increase waste or cost.

METHODS: Two units of thawed plasma are continuously maintained in the trauma bay blood refrigerator. After 3 days these units are replaced with freshly thawed plasma and returned to the blood bank for utilization prior to their 5-day expiration date. The blood bank monitors and rotates the plasma. Only trauma surgeons can use the plasma stored in the trauma bay. Wasted units and cost were measured over a 12-month period and compared to the previous 2 years.

RESULTS: The blood bank thawed 1127 units of plasma during the study period assigning 274 to the trauma bay. When compared to previous years, we found a significant increase in waste (p<0.001) and cost (p=0.020) after implementing our protocol. It cost approximately $125/month extra to maintain continuous access to thawed plasma during the study period.A protocol to maintain thawed plasma in the trauma bay at a rural level II trauma center resulted in a miniscule increase in waste and cost when considering the scope of maintaining a trauma center. We feel this cost is also minimal when compared to the value of having immediate access to thawed plasma. Constant availability of thawed plasma can be offered at smaller rural centers without a meaningful impact on cost.Level III; Economic & Value-based Evaluations.