1. Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study
- Author
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Matthay, Zachary A, Hellmann, Zane J, Callcut, Rachael A, Matthay, Ellicott C, Nunez-Garcia, Brenda, Duong, William, Nahmias, Jeffry, LaRiccia, Aimee K, Spalding, M Chance, Dalavayi, Satya S, Reynolds, Jessica K, Lesch, Heather, Wong, Yee M, Chipman, Amanda M, Kozar, Rosemary A, Penaloza, Liz, Mukherjee, Kaushik, Taghlabi, Khaled, Guidry, Christopher A, Seng, Sirivan S, Ratnasekera, Asanthi, Motameni, Amirreza, Udekwu, Pascal, Madden, Kathleen, Moore, Sarah A, Kirsch, Jordan, Goddard, Jesse, Haan, James, Lightwine, Kelly, Ontengco, Julianne B, Cullinane, Daniel C, Spitzer, Sarabeth A, Kubasiak, John C, Gish, Joshua, Hazelton, Joshua P, Byskosh, Alexandria Z, Posluszny, Joseph A, Ross, Erin E, Park, John J, Robinson, Brittany, Abel, Mary Kathryn, Fields, Alexander T, Esensten, Jonathan H, Nambiar, Ashok, Moore, Joanne, Hardman, Claire, Terse, Pranaya, Luo-Owen, Xian, Stiles, Anquonette, Pearce, Brenden, Tann, Kimberly, Abdul Jawad, Khaled, Ruiz, Gabriel, and Kornblith, Lucy Z
- Subjects
Adult ,Male ,Physical Injury - Accidents and Adverse Effects ,transfusion medicine ,Resuscitation ,Clinical Sciences ,Hemorrhage ,Blood Component Transfusion ,Nursing ,Cardiorespiratory Medicine and Haematology ,Trauma ,hemorrhagic shock ,Injury Severity Score ,Trauma Centers ,Risk Factors ,Clinical Research ,Humans ,Glasgow Coma Scale ,Hospital Mortality ,Retrospective Studies ,Age Factors ,Hematology ,Middle Aged ,Prognosis ,Thrombocytopenia ,Emergency & Critical Care Medicine ,Treatment Outcome ,Good Health and Well Being ,Wounds and Injuries ,Female - Abstract
BackgroundDespite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (UMT) (defined as ≥20 U of packed red blood cells [RBCs]) in 24 hours) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving UMT in the modern resuscitation era.MethodsAn Eastern Association for the Surgery of Trauma multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20 U of RBCs in 24 hours was performed (2014-2019). Multivariable logistic regression and Classification and Regression Tree analysis were used to identify clinical characteristics associated with mortality.ResultsThe 461 patients were young (median age, 35 years), male (82%), severely injured (median Injury Severity Score, 33), in shock (median shock index, 1.2; base excess, -9), and transfused a median of 29 U of RBCs, 22 U of fresh frozen plasma (FFP), and 24 U of platelets (PLT). Mortality was 46% at 24 hours and 65% at discharge. Transfusion of RBC/FFP ≥1.5:1 or RBC/PLT ≥1.5:1 was significantly associated with mortality, most pronounced for the 18% of patients who received both RBC/PLT and RBC/FFP ≥1.5:1 (odds ratios, 3.11 and 2.81 for mortality at 24 hours and discharge; both p < 0.01). Classification and Regression Tree identified that age older than 50 years, low initial Glasgow Coma Scale, thrombocytopenia, and resuscitative thoracotomy were associated with low likelihood of survival (14-26%), while absence of these factors was associated with the highest survival (71%).ConclusionDespite modern massive transfusion protocols, one half of trauma patients receiving UMT are transfused with either RBC/FFP or RBC/PLT in unbalanced ratios ≥1.5:1, with increased associated mortality. Maintaining focus on balanced ratios during UMT is critical, and consideration of advanced age, poor initial mental status, thrombocytopenia, and resuscitative thoracotomy can aid in prognostication.Level of evidencePrognostic, level III.
- Published
- 2021