D. R. Fraser1, A. Snow1, C. F. McNicoll1, P. J. Chestovich1, A. J. Chapman1, J. J. Fildes1 1University Of Nevada,Acute Care Surgery,Las Vegas, NV, USA
Introduction:
Trauma patients often receive large volume blood transfusions for life-threatening bleeding. Despite routine use of Massive Transfusions (MT) (≥ 10 units of packed red blood cells [PRBC]) in devastating injuries, the threshold for transfusion futility has yet to be established. When a trauma patient receives ≥ 10 units of PRBC, the surgeon must shepherd the continued resuscitative use of PRBC judiciously. Injury patterns may predict survival in MT patients, and guide blood product stewardship.
Methods:
A retrospective review of our level 1 trauma center’s registry was conducted to identify all trauma patients that received at least one blood product between June 2010 and June 2015. All PRBC, fresh frozen plasma (FFP), cryoprecipitate, and platelets transfused during the first 24 hours of admission were tabulated. Primary outcome was 30-day survival, by Abbreviated Injury Scale (AIS) body region, for patients who received ≥ 10 units of PRBC. Secondary outcomes included 30-day survival of patients who received ≥ 15 units of PRBC, by AIS body region. Stepwise reverse logistic regression was performed in STATA version 11, with statistical significance of p<0.05.
Results:
We identified 435 patients that received at least one blood product during the study period, with 75.4% men, mean age of 42.8 years, and 72.4% blunt injuries. Of these, 116 (26.7%) patients received a MT, and 319 (73.3%) did not. The range of all blood products transfused was 1 to 203 units. The range for the 415 patients that received any PRBC was 1 to 80 units. The survivor with the largest PRBC transfusion received 57 units. Percent 30-day survival by PRBC quantity transfused was 65.9% (n=299), 44.0% (n=91), 40.0% (n=20) and 20.0% (n=5) for groups of 1-9, 10-25, 26-50, and >50 units of PRBC transfused, respectively. The odds ratio (OR) for 30-day survival in MT patients compared to non-MT patients was 0.92 (p=0.01), after accounting for age, FFP:PRBC ratio, platelets, cryoprecipitate, and AIS body regions. Extremity (OR 4.98, p=0.002) and abdominal (OR 4.63, p=0.008) injuries correlated with improved survival in MT patients (Table 1). Chest injuries were associated with worse 30-day survival in MT patients, though not significant (OR 0.35, p=0.07). These effects persisted for PRBC transfusions ≥ 15 units.
Conclusion:
Survival in trauma patients requiring PRBC transfusion worsens with increasing volume. In MT patients, abdominal and extremity injuries had improved 30-day survival, while no significant difference could be found for other body regions. These findings will inform the surgeon’s decision making process for trauma patients requiring MT, and potentially improve the utilization of blood bank resources.
