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

Liu, Steven; Fujii, Quinn; Serio, Farris; McCague, Andrew

doi:10.29252/beat-060305

Cited by 12 publications

(16 citation statements)

References 19 publications

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“…Most research has focused on determining a transfusion threshold, based on the number of RBC units transfused, above which mortality increases significantly. 6,16,[27][28][29][30] Our study is unique in terms of demonstrating the predictive value of nadir pH, peak lactate, and age on in-hospital mortality among massively transfused patients across a broad range of surgical departments.…”

Section: Discussionmentioning

confidence: 97%

“…With respect to massive transfusions, we are unaware of any studies to date that have analyzed futility in the context of certain laboratory thresholds for pH and lactate. Most research has focused on determining a transfusion threshold, based on the number of RBC units transfused, above which mortality increases significantly 6,16,27–30 . Our study is unique in terms of demonstrating the predictive value of nadir pH, peak lactate, and age on in‐hospital mortality among massively transfused patients across a broad range of surgical departments.…”

Section: Discussionmentioning

confidence: 97%

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Assessing predictors of futility in patients receiving massive transfusions

Merkel

Dougherty

et al. 2021

Transfusion

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Background: Massive transfusions are associated with a high mortality rate, but there is little evidence indicating when such efforts are futile. The purpose of this study was to identify clinical variables that could be used as futility indicators in massively transfused patients. Methods: We retrospectively analyzed 138 adult surgical patients at our institution receiving a massive transfusion (2016)(2017)(2018)(2019). Peak lactate and nadir pH within 24 h of massive transfusion initiation, along with other clinical variables, were assessed as predictors of the primary outcome, in-hospital mortality. Results:The overall rate of in-hospital mortality among our patient population was 52.9% (n = 73). Increasing lactate and decreasing pH were associated with greater mortality among massively transfused patients. Mortality rates were~2-fold higher for patients in the highest lactate category (≥10.0 mmol/L: 25 of 37; 67.6%) compared to the lowest category (0.0-4.9 mmol/L: 17 of 48; 35.4%) (p = .005), and~2.5-fold higher for patients in the lowest pH category (<7.00: 8 of 9; 88.9%) compared to the highest category (≥7.40: 8 of 23; 34.7%) (p = .016). Increasing age was also associated with higher mortality (≥65 years: 24 of 33; 72.7%) when compared to younger patients (18-64 years: 49 of 105; 46.7%) (p = .010).Conclusions: Peak lactate ≥10.0 mmol/L, nadir pH <7.00, and age ≥65 years were significantly associated with higher rates of in-hospital mortality among massively transfused patients. Incorporating these clinical parameters into a futility index for massive transfusions will be useful in situations where blood products are scarce and/or mortality may be unavoidable.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Assessing predictors of futility in patients receiving massive transfusions

Merkel

Dougherty

et al. 2021

Transfusion

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“…6,7,27,30,33 Lo et al 7 recommended developing a futility index to predict when death may be unavoidable in spite of large volume blood administration, to aid physicians in medical decision-making during UMT in trauma. Liu et al 38 examined the mortality rates in trauma patients receiving MT (>10 units RBC/24 hours), and although the study was limited by its small sample size (n = 131), the authors suggested that 40 units RBC may be a potential cutoff value at which patient survival begins to decrease dramatically.…”

Section: Author Yearmentioning

confidence: 99%

Narrative Review: Is There a Transfusion Cutoff Value After Which Nonsurvivability Is Inevitable in Trauma Patients Receiving Ultramassive Transfusion?

Kim

Casem

Baral

et al. 2023

Anesthesia &Amp; Analgesia

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The institution of massive transfusion protocols (MTPs) has improved the timely delivery of large quantities of blood products and improves patient outcomes. In recent years, the cost of blood products has increased, compounded by significant blood product shortages. There is practical need for identification of a transfusion volume in trauma patients that is associated with increased mortality, or a threshold after which additional transfusion is futile and associated with nonsurvivability. This transfusion threshold is often described in the setting of an ultramassive transfusion (UMT). There are few studies defining what constitutes amount or outcomes associated with such large volume transfusion. The purpose of this narrative review is to provide an analysis of existing literature examining the effects of UMT on outcomes including survival in adult trauma patients and to determine whether there is a threshold transfusion limit after which mortality is inevitable. Fourteen studies were included in this review. The data examining the utility of UMT in trauma are of poor quality, and with the variability inherent in trauma patients, and the surgeons caring for them, no universally accepted cutoff for transfusion exists. Not surprisingly, there is a trend toward increasing mortality with increasing transfusions. The decision to continue transfusing is multifactorial and must be individualized, taking into consideration patient characteristics, institution factors, blood bank supply, and most importantly, constant reevaluation of the need for ongoing transfusion rather than blind continuous transfusion until the heart stops.

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“…A 2018 study of outcomes versus amount of blood transfused at one trauma center concluded that 40 units of packed red blood cells may constitute a threshold at which survival rates begin to decrease and futility can be considered [4]. A 1998 report on the upper limit to massive blood transfusion after severe trauma, however, had concluded that discontinuation of short-term care cannot be justified at less than 68 units [5].…”

Section: Introductionmentioning

confidence: 99%