Prevalence of Futility Protocols for Severely Bleeding Trauma Patients: A Survey from the Association for the Advancement of Blood & Biotherapies (AABB)

TL;DR

This study finds that trauma futility protocols are rare in US hospitals and blood centers, which may contribute to blood shortages for non-trauma patients.

Contribution

The first survey to assess the prevalence of trauma futility protocols and their impact on blood allocation.

Findings

Only 10.8% of responding institutions reported having trauma futility protocols.

Institutions with futility protocols were more likely to limit blood for non-trauma patients.

Implementing such protocols may help reduce blood shortages and wastage.

Abstract

Background/Objectives: The United States is facing a national blood shortage, which is a function of the reduced number of donors since the COVID-19 pandemic and the increasing use of balanced hemostatic resuscitation for severely bleeding trauma patients. As a result, recent attempts to define futility based on clinical and laboratory criteria have been proposed. There is no literature on the frequency of institutional futility protocols, either at hospitals or blood collection centers. Methods: The Association for the Advancement of Blood & Biotherapies sent out a survey to 800 United States hospitals and blood collection centers to determine the frequency of trauma futility protocols and the need to limit blood for non-trauma patients due to high use in trauma patients. Results: 213 (26.6%) institutions responded. 10.8% of hospitals and blood collection centers reported having a trauma futility protocol, and those hospitals and blood collection centers with futility protocols were more likely to have needed to limit blood to non-trauma patients due to high consumption by trauma patients. Conclusions: Trauma futility protocols at hospitals and blood collection centers are uncommon. Because of the national shortage of blood products available for trauma and non-trauma cases, implementing institutional trauma futility protocols may help to curb the incidence of blood limitation to non-trauma patients. Increased awareness and communication between blood bankers and traumatologists during the declaration of futility may reduce blood wastage and enhance the nation’s blood supply reservoirs.