F. Chaudhry1,2, L. Diebel1,2, A. Marinica1 1Detroit Medical Center, Surgery, Detroit, MI, USA 2Wayne State University, Surgery, Detroit, MI, USA
Introduction: Hypocalcemia in trauma patients has been associated with worse outcomes. Hypocalcemia manifests in trauma patients due to a combination of factors including hemorrhagic shock and citrate chelation from multiple transfusions. However, treatment of this hypocalcemia has been controversial and has yet to show significant benefit during intra-operative care of trauma patients. Here we show a preliminary report that a large portion of patients who go for emergent exploratory laparotomy or thoracotomy are persistently hypocalcemia intra-operatively. Of these patients, those whose average ionized calcium remained low may result in higher mortality.
Methods: We retrospectively collected data from 180 trauma patients at Detroit Medical Center Sinai Grace Hospital. We included only patients who had completed records, including vitals and intra-operative calcium recorded. Only patients who had an emergent exploratory laparotomy or a thoracotomy were included. Patients who had resuscitative thoracotomies in the emergency department were excluded. Patients with an average ionized calcium intra-operatively of less than 0.9 mmol/L were deemed to have persistent hypocalcemia, and those above 0.9 mmol/L were considered normocalcemic. We calculated the total resuscitation of blood products given and their respective citrate loads in (mL). Shock index was calculated as heart rate divided by systolic blood pressure. We also calculated the total amount of calcium in grams given. Primary endpoint was intra-operative mortality. A logistic regression model was used to identify associations, a P<0.05 was considered statistically significant with a 95% confidence interval.
Results:Of the 180 patients, 26 met criteria to be included in the study. 11/26 patients (42.6%) were persistently hypocalcemic. Age, sex, mechanism of injury and type of operation were similar between both groups. The median shock index was higher in the normocalcemic group, although not found to be statistically significant (1.24[1.00-1.90] vs 1.14[0.89-1.33], OR 3.38[0.63-26.4 CI]p>0.05). Median units of packed red blood cells, plasma, platelets and total citrate load were similar between both groups. Even though one of the groups was persistently hypocalcemic, they received the same amount of calcium as the normocalcemic group (3[2-6] vs 3[2-5], OR 0.99(0.73-1.36), p>0.05). Hypocalcemic patients were more likely to die intra-op, although unable to achieve statistical significance (4/11[36.4%] vs 3/15[20%], OR 0.44[0.068-2.54], P>0.05).
Conclusion:Operative trauma patients undergoing exploratory laparotomy or thoracotomy who were persistently hypocalcemic may have higher rates of mortality, yet most likely do not get enough calcium load. Our preliminary study supports future studies to more aggressively treat hypocalcemia during the intra-op period.
