Application of the Berlin definition in PROMMTT patients

Cotton, Bryan A.; Pritts, Timothy A.; Branson, Richard D.; Holcomb, John B.; Muskat, Peter; Fox, Erin E.; Wade, Charles E.; Junco, Deborah J. del; Bulger, Eileen M.; Cohen, Mitchell J.; Schreiber, Martin A.; Myers, John G.; Brasel, Karen J.; Phelan, Herb A.; Alarcon, Louis H.; Rahbar, Mohammad Hossein; Callcut, Rachael A.

doi:10.1097/ta.0b013e31828fa408

Cited by 42 publications

(21 citation statements)

References 37 publications

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“…Over the last decade, transfusion therapy has undergone a significant change with many patients receiving less crystalloid and early, more balanced transfusion ratios attempting to reconstitute whole blood. 4–12,27,32–41 This change has largely been associated with decreased transfusion amounts, fewer inflammatory complications, and improved survival. 4–12,27,32–41 …”

Section: Discussionmentioning

confidence: 99%

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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

Holcomb¹,

Tilley

Baraniuk

et al. 2015

JAMA

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2,006

1,561

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IMPORTANCE Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red blood cells), defined as damage control resuscitation, has been associated with improved outcomes; however, there have been no large multicenter clinical trials. OBJECTIVE To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, phase 3, multisite, randomized clinical trial of 680 severely injured patients who arrived at 1 of 12 level I trauma centers in North America directly from the scene and were predicted to require massive transfusion between August 2012 and December 2013. INTERVENTIONS Blood product ratios of 1:1:1 (338 patients) vs 1:1:2 (342 patients) during active resuscitation in addition to all local standard-of-care interventions (uncontrolled). MAIN OUTCOMES AND MEASURES Primary outcomes were 24-hour and 30-day all-cause mortality. Prespecified ancillary outcomes included time to hemostasis, blood product volumes transfused, complications, incidence of surgical procedures, and functional status. RESULTS No significant differences were detected in mortality at 24 hours (12.7% in 1:1:1 group vs 17.0% in 1:1:2 group; difference, −4.2% [95% CI, −9.6% to 1.1%]; P = .12) or at 30 days (22.4% vs 26.1%, respectively; difference, −3.7% [95% CI, −10.2% to 2.7%]; P = .26). Exsanguination, which was the predominant cause of death within the first 24 hours, was significantly decreased in the 1:1:1 group (9.2% vs 14.6% in 1:1:2 group; difference, −5.4% [95% CI, −10.4% to −0.5%]; P = .03). More patients in the 1:1:1 group achieved hemostasis than in the 1:1:2 group (86% vs 78%, respectively; P = .006). Despite the 1:1:1 group receiving more plasma (median of 7 U vs 5 U, P < .001) and platelets (12 U vs 6 U, P < .001) and similar amounts of red blood cells (9 U) over the first 24 hours, no differences between the 2 groups were found for the 23 prespecified complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. CONCLUSIONS AND RELEVANCE Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01545232

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Section: Discussionmentioning

confidence: 99%

“…4–12,27,32–41 Recent trauma resuscitation studies have demonstrated that most early deaths due to hemorrhage occur within 2 to 3 hours. 3,10,27,50,51 The PROMMTT study demonstrated a median time to hemorrhagic death from admission of 2.6 hours, 10 and in the PROPPR trial, the median time was 2.3 hours.…”

Section: Discussionmentioning

confidence: 99%

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

Holcomb¹,

Tilley

Baraniuk

et al. 2015

JAMA

Self Cite

2,006

1,561

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“…Increasing volumes of crystalloid, on the other hand, are associated inflammation (e.g. acute respiratory distress syndrome), 19 edema (e.g. abdominal compartment syndrome), 20 and mortality.…”

Section: Damage Control Resuscitation (Dcr)mentioning

confidence: 99%

Remote Damage Control Resuscitation in Austere Environments

Chang

Eastridge

Holcomb³

2017

Wilderness & Environmental Medicine

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Hemorrhage is the leading cause of preventable military and civilian trauma death. Damage control resuscitation (DCR) with concomitant mechanical hemorrhage control has become the preferred in-hospital treatment of hemorrhagic shock. In particular, plasma-based resuscitation with decreased volumes of crystalloids and artificial colloids as part of DCR has improved outcomes in the military and civilian sectors. However, translation of these principles and techniques to the prehospital, remote, and austere environments, known as remote damage control resuscitation or RDCR, is challenging given the resource limitations in these settings. Rapid administration of tranexamic acid and reconstituted freeze-dried (lyophilized) plasma as early as the point of injury are feasible and likely beneficial, but comparative studies in the literature are lacking. Whole blood is likely the best fluid therapy for traumatic hemorrhagic shock, but logistical hurdles need to be addressed. Rapid control of external hemorrhage with hemostatic dressings and extremity tourniquets are proven therapies, but control of non-compressible hemorrhage (i.e. torso hemorrhage) remains a significant challenge.

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“…97,98,99 Analysis of the prospectively-acquired PROMMTT dataset did not demonstrate an independent association between blood product use and moderate-to-severe hypoxemia. 37 Indeed, the PROPPR randomized trial found no difference in inflammatory or transfusion-related complications between the high and low ratio groups. 5 …”

Section: Pharmacologic Treatment Optionsmentioning

confidence: 98%

“…35,36 Analysis of the PROMMTT dataset found that increasing crystalloid use was independently associated with moderate or severe hypoxemia. 37 …”

Section: Pharmacologic Treatment Optionsmentioning

confidence: 99%

Optimal Fluid Therapy for Traumatic Hemorrhagic Shock

Chang¹,

Holcomb²

2017

Critical Care Clinics

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110

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The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge.

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Application of the Berlin definition in PROMMTT patients

Cited by 42 publications

References 37 publications

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

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

Remote Damage Control Resuscitation in Austere Environments

Optimal Fluid Therapy for Traumatic Hemorrhagic Shock

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