Background and Goal of Study: Today, massive bleeding (MB) is one of the conditions with highest death rates. It may occur in different clinical settings such as cardiovascular surgery, obstetrics or trauma. Current guidelines recommend to guide the assistance through a massive transfusion protocol (MTP).The goal of this study is to educate about the MTP in a tertiary university referral hospital. It is imporant to find out our physicians knowledge on MTP, if transfusion knowledge is related to a better transfusion practice (TP) and to describe which are the main parameters to start transfusional support in MB.
Materials and Methods: After local ethics committee approval (HULP: PI-230) an anonymous survey was developed in six departments; Anesthesia (AR), Emergency (ED), Internal medicine (IM), Orthopedics (OT), Intensive Care Unit (ICU) and General Surgery (GS).Data were collected throughout a three-month period (Dec 15'-Feb 16'). Pearson's chi-square test, Fisher exact test and likelihood ratio was used for qualitative variables.
Results and Discussion: 125/302 surveys were sent back (41.3%). 76% (N=95) were staff members and 23.2%(N=29) were residents. 74.2%(N=92) were familiar with the existence of a MTP at hospital while 25.8%(N=32) were unaware of its existence. Data obtained in each department is shown on table 1.
Group	Residents	Staff	AR	ED	ICU	IM	OT	GS
%	86.2	70.2	86.4	90	85.7	53.3	8.3	50
n	25	66	51	18	12	8	1	2
[Table 1: % physicians who know about the MTP]
67.2% (N=84) of doctors had received education about TP. 89.2% (N=74) of trained doctors were aware of the MTP vs 42.5%(N=17) of non-trained (p< 0.001). 
A trend was observed between frequently use of transfusions and higher knowledge about MTP (p= 0.177). Main triggers for transfusion were patient's clinical status plus Hemoglobin (Hb) value in 75% (N=54) while isolated Hb value was in 25% (N=18). Physicians trained in TP had a tendency to use isolated Hb value more frecuently than those without it (30.6% vs 13.0%), although we couldn't find statistically significant (SS) differences (p=0.108). A bigger sample might be useful to demonstrate SS differences.
Conclusions: Our physicians knowledge rate in MTP and transfusion practice is low, even lower when it's related to medical specialties who don't deal often with MB. Transfusional training doesn't seem related to a better transfusional practice. Isolated hemoglobin level is used by one out of four doctors to prescribe blood products.

Massive transfusion protocol in a tertiary university hospital. Is it followed by surgeons, anesthesiologists and other medical specialists?