M. Alpert1, A. Grigorian2, C. Krasnoff2, R. Bashir2, G. Kojayan2, R. Homo2, C. M. Kuza3, J. Nahmias2 1Western University of Health Sciences,College Of Osteopathic Medicine Of The Pacific,Pomona, CA, USA 2University Of California – Irvine,Department Of Surgery, Division Of Trauma, Burns And Surgical Critical Care,Orange, CA, USA 3University Of Southern California,Department Of Anesthesiology,Los Angeles, CA, USA
Introduction: Hemorrhage is the leading cause of early preventable death for trauma patients. Patients receiving a balanced massive transfusion (MT) resuscitation have been demonstrated to have decreased mortality and a lower rate of trauma-related coagulopathy. We hypothesized that trauma patients receiving a balanced resuscitation have a lower risk of mortality compared to those receiving a non-balanced resuscitation during MT.
Methods: The Trauma Quality Improvement Program was queried (2014-2016) for all trauma patients who received ≥10 packed red blood cell (PRBC) units within the first 24 hours of admission. These patients were divided into balanced and unbalanced resuscitations. Balanced resuscitation patients received a 1:1 ratio of PRBC to fresh frozen plasma and non-balanced resuscitation patients received a 1.6:1 ratio. A multivariable logistic regression model was used to determine risk for mortality.
Results: Of the 7,697 patients, 482 (6.3%) received a balanced resuscitation and 7,215 (93.7%) received a non-balanced resuscitation. The two cohorts had a similar median injury severity score (ISS) (33.0 vs. 29.0 in the non-balanced resuscitation cohort, p>0.05). There was no difference in rates of mortality (46.9% vs. 44.8% in the non-balanced resuscitation cohort, p>0.05). After adjusting for age, ISS, and severe head injury, the risk of mortality was similar in both balanced and unbalanced MT groups (p>0.05).
Conclusion: In a large national cohort, the incidence of balanced resuscitation among trauma patients receiving a MT was less than 7%. However, the risk of mortality was similar between those receiving a 1:1 ratio and a non-balanced ratio of 1.6:1. Future research is needed to determine the minimum ratio where risk of mortality decreases in order to benchmark the ratio of resuscitation for adult trauma patients.
