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.