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Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time.

Peralta R, Vijay A, El-Menyar A, Consunji R, Abdelrahman H, Parchani A, Afifi I, Zarour A, Al-Thani H, Latifi R - World J Emerg Surg (2015)

Bottom Line: However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001).The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases).The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

View Article: PubMed Central - PubMed

Affiliation: Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.

ABSTRACT

Objective: We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).

Methods: A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.

Results: During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

Conclusions: Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.

No MeSH data available.


Related in: MedlinePlus

Outcome according to time post-injury (hours) and transfusion ratio (HMTP vs. LMTP) (a) multiorgan failure (MOF) (b) overall mortality
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Fig2: Outcome according to time post-injury (hours) and transfusion ratio (HMTP vs. LMTP) (a) multiorgan failure (MOF) (b) overall mortality

Mentions: The overall mortality was 63.6 % (Table 3). Patients who died mainly had lung contusion (42.9 %), head injury (29.9 %), pelvic fracture (28.6 %), liver injury (24.7 %) and rib fractures (23.4 %). Moreover, significant number of patients in HMTP group who died had more rib fractures (66.7 % vs. 27.8 %; P = 0.01) than LMTP group. A non-significantly higher proportion of patients in LMTP group died within 6 h post-injury in comparison to HMTP. During the early period of resuscitation (<4 h), the incidence of MOF (48.4 % vs. 87.0 %, p = 0.001) and crude mortality (41.9 % vs.78.3 %, p = 0.001) were significantly lower in HMTP compared to LMTP group. However, in the later period (4–24 h) MOF and mortality were comparable among the two groups (Fig. 2).Table 3


Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time.

Peralta R, Vijay A, El-Menyar A, Consunji R, Abdelrahman H, Parchani A, Afifi I, Zarour A, Al-Thani H, Latifi R - World J Emerg Surg (2015)

Outcome according to time post-injury (hours) and transfusion ratio (HMTP vs. LMTP) (a) multiorgan failure (MOF) (b) overall mortality
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536606&req=5

Fig2: Outcome according to time post-injury (hours) and transfusion ratio (HMTP vs. LMTP) (a) multiorgan failure (MOF) (b) overall mortality
Mentions: The overall mortality was 63.6 % (Table 3). Patients who died mainly had lung contusion (42.9 %), head injury (29.9 %), pelvic fracture (28.6 %), liver injury (24.7 %) and rib fractures (23.4 %). Moreover, significant number of patients in HMTP group who died had more rib fractures (66.7 % vs. 27.8 %; P = 0.01) than LMTP group. A non-significantly higher proportion of patients in LMTP group died within 6 h post-injury in comparison to HMTP. During the early period of resuscitation (<4 h), the incidence of MOF (48.4 % vs. 87.0 %, p = 0.001) and crude mortality (41.9 % vs.78.3 %, p = 0.001) were significantly lower in HMTP compared to LMTP group. However, in the later period (4–24 h) MOF and mortality were comparable among the two groups (Fig. 2).Table 3

Bottom Line: However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001).The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases).The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

View Article: PubMed Central - PubMed

Affiliation: Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.

ABSTRACT

Objective: We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).

Methods: A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.

Results: During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

Conclusions: Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.

No MeSH data available.


Related in: MedlinePlus