Massive Blood Transfusions and Outcomes in Trauma Patients; An Intention to Treat Analysis

Steven Liu, Quinn Fujii, Farris Serio, Andrew McCague

Abstract

Objective: To determine if there exists an upper limit for amount of blood transfused in trauma patients before it reaches a point of futility.

Methods: A prospective cohort study was conducted on 131 patients who received massive blood transfusion (MBT), defined as 10 U or higher of PRBCs received in the initial 24 hours. Data collected from a Level II trauma center registry were used to analyze reports of adult patients from July 2014 to 2017. Cohorts were divided by amount of blood received - 0 to 9 U, 10-19 U, 20 to 29 U, 30-39 U, 40 U or higher - odds ratio for mortality and p-values for mean Injury Severity Score and overall hospital length of stay were calculated for each group.

Results: Odds ratios for massive blood transfusion groups from 10 units to 39 units each contained the null value, while our 40 units and above group did not (OR 12.52, 95% CI 1.3-117.7).

Conclusion: Although this study is limited by its sample size, these results suggests that 40 units of PRBCs may be a threshold at which survival rates begin to decrease significantly.

Keywords

Massive transfusion; Blood transfusion; Trauma; Blood loss

Full Text:

PDF XML HTML

References

Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian journal of anaesthesia. 2014;58(5):590.

Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. Jama. 2015;313(5):471-82.

Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med. 1992;20(1):80-93.

Geller ER. Shock and resuscitation. McGraw-Hill: Health Professions Division; 1993.

Mikulaschek A, Henry SM, Donovan R, Scalea TM. Serum lactate is not predicted by anion gap or base excess after trauma resuscitation. J Trauma. 1996;40(2):218-22; discussion 22-4.

Davis JW, Parks SN, Kaups KL, Gladen HE, O'Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41(5):769-74.

Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-17.

Paydar S, Sabetian G, Khalili H, Abbasi HR, Bolandparvaz S, Ghahramani Z, et al. Shiraz Trauma Transfusion Score: A Scoring System for Blood Transfusion in Trauma Patients. Bull Emerg Trauma. 2016;4(3):121-3.

Savage SA, Sumislawski JJ, Zarzaur BL, Dutton WP, Croce MA, Fabian TC. The new metric to define large-volume hemorrhage: results of a prospective study of the critical administration threshold. J Trauma Acute Care Surg. 2015;78(2):224-9; discussion 9-30.

Siegel JH. The effect of associated injuries, blood loss, and oxygen debt on death and disability in blunt traumatic brain injury: the need for early physiologic predictors of severity. J Neurotrauma. 1995;12(4):579-90.

Britt LD, Weireter LJ, Jr., Riblet JL, Asensio JA, Maull K. Priorities in the management of profound shock. Surg Clin North Am. 1996;76(4):645-60.

Brown JB, Cohen MJ, Minei JP, Maier RV, West MA, Billiar TR, et al. Goal-directed resuscitation in the prehospital setting: a propensity-adjusted analysis. J Trauma Acute Care Surg. 2013;74(5):1207-12; discussion 12-4.

Velmahos GC, Chan L, Chan M, Tatevossian R, Cornwell EE, 3rd, Asensio JA, et al. Is there a limit to massive blood transfusion after severe trauma? Arch Surg. 1998;133(9):947-52.

Vaslef SN, Knudsen NW, Neligan PJ, Sebastian MW. Massive transfusion exceeding 50 units of blood products in trauma patients. J Trauma. 2002;53(2):291-5; discussion 5-6.

Cinat ME, Wallace WC, Nastanski F, West J, Sloan S, Ocariz J, et al. Improved survival following massive transfusion in patients who have undergone trauma. Arch Surg. 1999;134(9):964-8; discussion 8-70.

Walker J, Criddle LM. Massive transfusion: don't stop. J Emerg Nurs. 2002;28(2):176-8.

Alam HB, Rhee P. New developments in fluid resuscitation. Surg Clin North Am. 2007;87(1):55-72, vi.

Bilkovski RN, Rivers EP, Horst HM. Targeted resuscitation strategies after injury. Curr Opin Crit Care. 2004;10(6):529-38.

Garcia A. Critical care issues in the early management of severe trauma. Surg Clin North Am. 2006;86(6):1359-87.

Napolitano LM, Kurek S, Luchette FA, Corwin HL, Barie PS, Tisherman SA, et al. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med. 2009;37(12):3124-57.