Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at US Level 1 Trauma Centers.

Journal Article (Journal Article)


Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs.


Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients.


A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20-90), considering platelets. Ten TCs exhaust their supply of platelets prior to red blood cells (RBCs) or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed RBCs, six exhausted their AB plasma supply, and five had a mixed exhaustion picture.


Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, which have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.

Full Text

Duke Authors

Cited Authors

  • Williams, J; Gustafson, M; Bai, Y; Prater, S; Wade, CE; Guillamondegui, OD; Khan, M; Brenner, M; Ferrada, P; Roberts, D; Horer, T; Kauvar, D; Kirkpatrick, A; Ordonez, C; Perreira, B; Priouzram, A; Duchesne, J; Cotton, BA

Published Date

  • December 2021

Published In

Volume / Issue

  • 56 / 1S

Start / End Page

  • 62 - 69

PubMed ID

  • 33470606

Pubmed Central ID

  • PMC8601667

Electronic International Standard Serial Number (EISSN)

  • 1540-0514

International Standard Serial Number (ISSN)

  • 1073-2322

Digital Object Identifier (DOI)

  • 10.1097/shk.0000000000001719


  • eng