N. W. Kugler1, T. Spees1, C. Pinkertson1, J. Paul2, O. Kaslow1, E. Hanko1, T. Carver1 1Medical College Of Wisconsin,Milwaukee, WI, USA 2University Of New Mexico HSC,Albuquerque, NM, USA
Introduction: Hemostatic resuscitation (HR) focusing on balanced ratios of blood products and minimizing crystalloids has been used to improve outcomes in patients with exsanguinating blood loss from trauma. Our institution implemented a Massive Transfusion protocol (MT) to facilitate HR and participate in prospective trials. Over five years four distinct time periods were noted; (1) Pre- HR, (2) the PROMMTT study, (3) Transition and (4) the PROPPR study. The aim of this study was to determine whether the implementation and utilization of an MT protocol and change in resuscitation patterns affected our use of Damage Control Laparotomy (DCL) in management of trauma patients with exsanguinating blood loss.
Methods: An IRB approved retrospective chart review of adult trauma patients identified through the trauma registry and operative logs whom underwent exploratory laparotomy within the first 24-hours of their index admission between January 1, 2008 and December 31, 2013 was conducted. Demographics, mechanism of injury, and an ABC Score for Massive Transfusion was calculated. Prehospital, trauma room, and intraoperative crystalloid and blood product administration were recorded. Exploratory laparotomies were scored as primary closure or DCL under several defined categories. Four distinct time periods were defined as above by differences in resuscitation strategies.
Results: A total of 755 patients underwent exploratory laparotomy over the study period. 27 were excluded for delayed laparotomy, 27 excluded due to intraoperative death, and 18 excluded due to missing data resulting in 683 patients. The overall rate of DCL was 17.7%. A total of 131 patients with an ABC score of two or three were identified comprising the study group: median age 31 years (IQR 24,44), majority penetrating (90.1%), ISS 13 (IQR 9,25), and AIS abdomen 3 (IQR 3,3). Analysis demonstrates no significant differences in the overall rate of DCL (35%, 40%, 40.9%, 40%) or when controlling DCL due to injury pattern (18.8%, 25%, 30.4%, 25%) for the defined time periods.
Conclusion: Changes in resuscitation through MT and maximizing hemostatic resuscitation does not appear to impact the rate of DCL, even when controlling specific injury patterns.