Volume 30, Issue 168, February 2026

Impact of Massive Transfusion Protocol Implementation on Survival, Blood Product Utilization, and Quality Indicators in Trauma: A Systematic Reviews

Mazi Mohammed Alanazi¹, Mohammed Aamer A Alsuwaigh², Abdullah Ahmad A Twair³, Abdulmajeed Salem Alkraidis⁴

¹Saudi and Jordanian Board Emergency Medicine, Emergency Department, Head of Emergency Research Unit, First Health Cluster, Riyadh, Saudi Arabia
²Saudi Board Emergency Medicine Resident, Emergency Department, First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia
³Saudi Board Emergency Medicine Resident, Emergency Department, Second Health Cluster, King Fahad Medical City, Riyadh, Saudi Arabia
⁴Assistant Consultant General Surgery, Department of general surgery, Prince Mohammad bin Abdulaziz Hospital, Riyadh, Saudi Arabia

ABSTRACT

Background: Massive transfusion protocols (MTPs) decrease traumatic hemorrhage mortality, allow balanced blood component replacement, and decrease the delays in hypothermia correction. Method: We reviewed the original studies on MTP implementation, and we include eight single and multicenter cohorts. The included studies evaluated performance indicators (KPIs), protocol adherence, WB timing, rural WB program implementation, sociodemographic patterns in MTP use, and effects of protocol adoption. Result: according to the included studies earlier WB use and more balanced transfusion ratios were associated with lower mortality. Eight original studies were included in January 2020 to July 2025. Two cohort studies assessed MTP implementation, one cohort examined the association between protocol adherence and survival, and a large U.S. cohort evaluated whether earlier WB was associated with improved survival. A study in U.S described outcomes and wastage after implementing a WB program. One Indian study developed KPIs for MTP. MTP implementation and performance monitoring are associated with improved outcomes and processes in trauma systems. Conclusion: Current research deficits persist, notably the lack of consensus regarding criteria for therapeutic futility and the absence of standardized definitions for clinical outcomes. A critical remaining gap is the evaluation of viscoelastic guided, precision resuscitation protocols. To address these issues, we advocate for the development of a practiceoriented evidence map that delineates key priorities for standardization and facilitates quality improvement initiatives focused on equity in care delivery.

Keywords: massive transfusion; trauma; damage control resuscitation; whole blood; protocol adherence; time to transfusion

Medical Science, 2026, 30, e25ms3759

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DOI: https://doi.org/10.54905/disssi.v30i168.e25ms3759

Published: 09 February 2026