Real‐time performance improvement optimizes damage control resuscitation best practice adherence: Results of a pilot prospective observational study

Background Maintaining balanced blood product ratios during damage control resuscitation (DCR) is independently associated with improved survival. We hypothesized that real‐time performance improvement (RT‐PI) would increase adherence to DCR best practice. Study Design and Methods From December 2020–August 2021, we prospectively used a bedside RT‐PI tool to guide DCR in severely injured patients surviving at least 30 min. RT‐PI study patients were compared to contemporary control patients at our institution and historic PROMMTT study patients. A subset of patients transfused ≥6 U red blood cells (RBC) in 6 h (MT+) was also identified. The primary endpoint was percentage time in a high ratio range (≥3:4) of plasma (PLAS):RBC and platelet (PLT):RBC over 6 h. Secondary endpoints included time to massive transfusion protocol activation, time to calcium and tranexamic acid (TXA) dosing, and cumulative 6‐h ratios. Results Included patients ( n = 772) were 35 (24–51) years old with an Injury Severity Score of 27 (17–38) and 42% had penetrating injuries. RT‐PI ( n = 10) patients spent 96% of the 6‐h resuscitation in a high PLAS:RBC range, no different versus CONTROL ( n = 87) (96%) but more than PROMMTT ( n = 675) (25%, p < .001). In the MT+ subgroup, optimal PLAS:RBC and PLT:RBC were maintained for the entire 6 h in RT‐PI ( n = 4) versus PROMMTT ( n = 391) patients for both PLAS ( p < .001) and PLT ratios ( p < .001). Time to TXA also improved significantly in RT‐PI versus CONTROL patients (27 min [22–31] vs. 51 min [29–98], p = .035). Conclusion In this prospective study, RT‐PI was associated with optimized DCR. Multicenter validation of this novel approach to optimizing DCR implementation is warranted.