دورية أكاديمية
Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study.
| العنوان: | Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study. |
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| المؤلفون: | Matthay ZA; From the Department of Surgery at Zuckerberg San Francisco General Hospital, University of California San Francisco (Z.A.M., Z.J.H., R.A.C., B.N.-G., L.Z.K., E.E.R., J.J.P., B.R., M.K.A., A.T.F.), San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco (E.C.M), San Francisco, California; Department of Laboratory Medicine, University of California, San Francisco (J.H.E., A.N., J.M.), San Francisco, California; Department of Surgery, University of California Irvine (W.D., J.N.), Irvine, Orange, California; Department of Surgery, Ohio Health Grant Medical Center (A.K.L., M.C.S.), Columbus, Ohio; Department of Surgery, University of Kentucky (S.S.D., J.K.R.), Lexington, Kentucky; Department of Surgery, Miami Valley Hospital (H.L., Y.W., C.H.), Dayton, Ohio; Department of Surgery, R Adams Cowley Shock Trauma Center (A.M.C., R.A.K., P.T.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, Loma Linda Medical Center (L.P., K.M., X.L.-O.), Loma Linda, California; Department of Surgery, University of Kansas Medical Center (K.T., C.A.G.), Kansas City, Kansas; Department of Surgery, Crozer-Chester Medical Center (S.S.S., A.R.), Upland, Pennsylvania; Department of Surgery, WakeMed Health and Hospitals (A.M., P.U., A.S., B.P., K.T.), Raleigh, North Carolina; Department of Surgery, University of New Mexico School of Medicine (K.M., S.A.M.), Albuquerque, New Mexico; Department of Surgery, Wellspan York Hospital (J.G.), York, Pennsylvania; Department of Surgery, Ascension Via Christi Hospitals St. Francis (J.K., J.H., K.L.), Wichita, Kansas; Department of Surgery, Maine Medical Center (J.B.O., D.C.C.), Portland, Maine; Department of Surgery, South Shore Hospital/Brigham and Women's Hospital (S.A.S., J.C.K.), Boston, Massachusetts; Department of Surgery, Penn State Hershey Medical Center (J.G., J.P.H.), Hershey, Pennsylvania; Department of Surgery, Northwestern University Feinberg School of Medicine (A.Z.B., J.A.P.), Chicago, Illinois; Department of Surgery, University of California (R.A.C.), UC Davis, Sacramento, California; Department of Surgery, Ryder Trauma Center (K.A.J., G.R.), University of Miami Miller School of Medicine, Miami, Florida; and Washington University School of Medicine St. Louis (J.K.), Missouri., Hellmann ZJ, Callcut RA, Matthay EC, Nunez-Garcia B, Duong W, Nahmias J, LaRiccia AK, Spalding MC, Dalavayi SS, Reynolds JK, Lesch H, Wong YM, Chipman AM, Kozar RA, Penaloza L, Mukherjee K, Taghlabi K, Guidry CA, Seng SS, Ratnasekera A, Motameni A, Udekwu P, Madden K, Moore SA, Kirsch J, Goddard J, Haan J, Lightwine K, Ontengco JB, Cullinane DC, Spitzer SA, Kubasiak JC, Gish J, Hazelton JP, Byskosh AZ, Posluszny JA, Ross EE, Park JJ, Robinson B, Abel MK, Fields AT, Esensten JH, Nambiar A, Moore J, Hardman C, Terse P, Luo-Owen X, Stiles A, Pearce B, Tann K, Abdul Jawad K, Ruiz G, Kornblith LZ |
| المصدر: | The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2021 Jul 01; Vol. 91 (1), pp. 24-33. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 101570622 Publication Model: Print Cited Medium: Internet ISSN: 2163-0763 (Electronic) Linking ISSN: 21630755 NLM ISO Abbreviation: J Trauma Acute Care Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins |
| مواضيع طبية MeSH: | Blood Component Transfusion/*methods , Hemorrhage/*therapy , Resuscitation/*methods , Thrombocytopenia/*epidemiology , Wounds and Injuries/*therapy, Adult ; Age Factors ; Blood Component Transfusion/statistics & numerical data ; Female ; Glasgow Coma Scale ; Hemorrhage/diagnosis ; Hemorrhage/etiology ; Hemorrhage/mortality ; Hospital Mortality ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Thrombocytopenia/etiology ; Thrombocytopenia/therapy ; Trauma Centers/statistics & numerical data ; Treatment Outcome ; Wounds and Injuries/complications ; Wounds and Injuries/diagnosis ; Wounds and Injuries/mortality |
| مستخلص: | 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. Level of Evidence: Prognostic, level III. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.) |
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| معلومات مُعتمدة: | K23 GM130892 United States GM NIGMS NIH HHS; L30 HL138770 United States HL NHLBI NIH HHS; R01 HL149670 United States HL NHLBI NIH HHS |
| تواريخ الأحداث: | Date Created: 20210618 Date Completed: 20210923 Latest Revision: 20230825 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC8243874 |
| DOI: | 10.1097/TA.0000000000003121 |
| PMID: | 34144557 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2163-0763 |
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| DOI: | 10.1097/TA.0000000000003121 |