Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Abstract

Purpose To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients. Methods A retrospective cohort study (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) including 260 patients receiving C10 RBC units B24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes. ]).Conclusions Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion. RésuméObjectif De´terminer les associations qui existent entre la transfusion d'e´rythrocytes et les devenirs cliniques R. A. Fowler and N. K. J. Adhikari contributed equally to this study.

Persistence of Elevated Plasma CXCL8 Concentrations Following Red Blood Cell Transfusion in a Trauma Cohort

“…Thirty-three of the 88 individuals received massive transfusion (> 10 packed RBC units) and/or had ongoing transfusions on arrival to the emergency room. As these individuals represented a clinically distinct cohort with higher hospital mortality(22–24), we excluded them from further analysis. We restricted our temporal analysis to subjects with at least 3 plasma samples within the first 48 h of admission in order to ensure an appropriate sampling for longitudinal analysis and to minimize any bias stemming from missing data.…”

Transfusion Approaches and Mortality in Trauma Patients: A Narrative Review

“…12,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] These studies varied in outcomes and treatment approach, with mortality and ISS varying widely (ISS: 16.8-42.5). The highest mortality rates were observed in critically ill patients receiving ultramassive (defined as transfusion of 20 U RBC over the course of any 2 consecutive calendar days) or massive transfusions (mortality rates of 63% at 30 days and 58.5% while in hospital, respectively), 27,41 patients with coagulopathies (30day mortality: 50%), 32 and patients with a greater degrees of hemodynamic instability (group with highest Shock Index stratification had mortality rate of 39.8%). 33 Similarly, critically ill patients and those with early mortality were often treated with the highest numbers of blood products.…”

The use of trauma transfusion pathways for blood component transfusion in the civilian population: a systematic review and meta‐analysis*

“…Haemorrhage remains the second leading cause of death amongst trauma patients in North America (Sauaia et al, 1995;Kauvar et al, 2006). For patients requiring massive blood transfusion after trauma, mortality rates range from 40 to 60%, and recently great emphasis has been placed on strategies to reduce the mortality and morbidity rates in these patients (Hoyt et al, 1994;Hess & Zimrin, 2005;Mahambrey et al, 2009).…”

“…Blood component therapy was introduced in the 1970s as a means to decrease the risk of infectious disease transmission associated with whole blood replacement. Since that time, blood component transfusions have traditionally been based on laboratory indices of coagulation (Armand & Hess, 2003;Fraga et al, 2009;Mahambrey et al, 2009). Concern has been raised, however, that this reactive strategy does not adequately address the coagulopathy of trauma present in most severely injured trauma patients at the time of hospital presentation (Armand & Hess, 2003;Brohi et al, 2007;Fraga et al, 2009;Murthi et al, 2009).…”

“…Largely in response to the military literature, many trauma centres have implemented pathways (TTPs) for the transfusion of blood components to the severely injured trauma patients. Early reports on the introduction of these pathways have largely demonstrated favourable outcomes; however, concern has been raised about the potential increase in the overall number of blood products transfused and the risks associated with increasing the number of units transfused (Brohi et al, 2007;Holcomb et al, 2007;Fraga et al, 2009;Mahambrey et al, 2009;Murthi et al, 2009;Napolitano et al, 2009;Sadjadi et al, 2009;Watson et al, 2009). No randomised controlled trials have been published comparing the use of a TTP to historical transfusion strategies; however, a synthesis of the observational study data may provide insight into the efficacy of these pathways in severely injured trauma patients.…”