Journal article
Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study
The journal of trauma and acute care surgery, v 91(1), pp 24-33
01 Jul 2021
PMID: 34144557
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND Despite 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. METHODS An 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. RESULTS The 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%). CONCLUSION Despite 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.
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Details
- Title
- Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study
- Creators
- Zachary A. Matthay - University of Maryland, BaltimoreZane J. Hellmann - University of Maryland, BaltimoreRachael A. Callcut - University of Maryland, BaltimoreEllicott C. Matthay - University of Maryland, BaltimoreBrenda Nunez-Garcia - University of Maryland, BaltimoreWilliam Duong - University of Maryland, BaltimoreJeffry Nahmias - University of Maryland, BaltimoreAimee K. LaRiccia - University of Maryland, BaltimoreM. Chance Spalding - University of Maryland, BaltimoreSatya S. Dalavayi - University of Maryland, BaltimoreJessica K. Reynolds - University of Maryland, BaltimoreHeather Lesch - University of Maryland, BaltimoreYee M. Wong - University of Maryland, BaltimoreAmanda M. Chipman - University of Maryland, BaltimoreRosemary A. Kozar - University of Maryland, BaltimoreLiz Penaloza - College Station Medical CenterKaushik Mukherjee - University of Maryland, BaltimoreKhaled Taghlabi - University of Maryland, BaltimoreChristopher A. Guidry - University of Maryland, BaltimoreSirivan S. Seng - University of Maryland, BaltimoreAsanthi Ratnasekera - University of Maryland, BaltimoreAmirreza Motameni - University of Maryland, BaltimorePascal Udekwu - University of Maryland, BaltimoreKathleen Madden - University of Maryland, BaltimoreSarah A. Moore - University of Maryland, BaltimoreJordan Kirsch - University of Maryland, BaltimoreJesse Goddard - University of Maryland, BaltimoreJames Haan - Ascension Via ChristiKelly Lightwine - Ascension Via ChristiJulianne B. Ontengco - Maine Medical CenterDaniel C. Cullinane - University of Maryland, BaltimoreSarabeth A. Spitzer - University of Maryland, BaltimoreJohn C. Kubasiak - University of Maryland, BaltimoreJoshua Gish - University of Maryland, BaltimoreJoshua P. Hazelton - University of Maryland, BaltimoreAlexandria Z. Byskosh - University of Maryland, BaltimoreJoseph A. Posluszny - University of Maryland, BaltimoreErin E. Ross - University of Maryland, BaltimoreJohn J. Park - University of Maryland, BaltimoreBrittany Robinson - University of Maryland, BaltimoreMary Kathryn Abel - University of Maryland, BaltimoreAlexander T. Fields - University of Maryland, BaltimoreJonathan H. Esensten - University of Maryland, BaltimoreAshok Nambiar - University of Maryland, BaltimoreJoanne Moore - Via Christi HospitalClaire Hardman - University of Maryland, BaltimorePranaya Terse - University of Maryland, BaltimoreXian Luo-Owen - University of Maryland, BaltimoreAnquonette Stiles - University of Maryland, BaltimoreBrenden Pearce - University of Maryland, BaltimoreKimberly Tann - University of Maryland, BaltimoreKhaled Abdul Jawad - University of Maryland, BaltimoreGabriel Ruiz - University of Maryland, BaltimoreLucy Z. Kornblith - University of Maryland, Baltimore
- Publication Details
- The journal of trauma and acute care surgery, v 91(1), pp 24-33
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 10
- Grant note
- 1K23GM130892-01 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000668996000011
- Scopus ID
- 2-s2.0-85108671132
- Other Identifier
- 991022056900604721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Surgery