Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center

Christopher J. Dente, Beth H. Shaz, Jeffery M. Nicholas, Robert S. Harris, Amy D. Wyrzykowski, Snehal Patel, Amit Shah, Gary A. Vercruysse, David V. Feliciano, Grace S. Rozycki, Jeffrey P. Salomone, Walter L. Ingram

Research output: Contribution to journalArticle

230 Scopus citations

Abstract

INTRODUCTION: Transfusion practices across the country are changing with aggressive use of plasma (fresh-frozen plasma [FFP]) and platelets during massive transfusion with current military recommendations to use component therapy at a 1:1:1 ratio of packed red blood cells to FFP to platelets. METHODS: A massive transfusion protocol (MTP) was designed to achieve a packed red blood cell:FFP:platelet ratio of 1:1:1 We prospectively gathered demographic, transfusion, and patient outcome data during the first year of the MTP and compared this with a similar cohort of injured patients (pre-MTP) receiving ≥10 red blood cell (RBC) in the first 24 hours of hospitalization before instituting the MTP. RESULTS: One hundred sixteen MTP activations occurred. Twelve non-trauma patients and 31 who did not receive 10 RBC (15 deaths, 16 early bleeding controls) were excluded. Seventy-three MTP patients were compared with 84 patients with pre-MTP who had similar demographics and injury severity score (29 vs. 29, p = 0.99). MTP patients received an average of 23.7 RBC and 15.6 FFP transfusions compared with 22.8 RBC (p = 0.67) and 7.6 FFP (p < 0.001) transfusions in pre-MTP patients. Early crystalloid usage dropped from 9.4 L (pre-MTP) to 6.9 L (MTP) (p = 0.006). Overall patient mortality was markedly improved at 24 hours, from 36% in the pre-MTP group to 17% in the MTP group (p = 0.008) and at 30 days (34% mortality MTP group vs. 55% mortality in pre-MTP group, p = 0.04). Blunt trauma survival improvements were more marked and more sustained than victims of penetrating trauma. Early deaths from coagulopathic bleeding occurred in 4 of 13 patients in the MTP group vs. 21 of 31 patients in the pre-MTP group (p = 0.023). CONCLUSIONS: In the civilian setting, aggressive use of FFP and platelets drastically reduces 24-hour mortality and early coagulopathy in patients with trauma. Reduction in 30 day mortality was only seen after blunt trauma in this small subset.

Original languageEnglish (US)
Pages (from-to)1616-1624
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue number6
DOIs
StatePublished - Jun 2009

Keywords

  • Coagulopathy after trauma
  • Component therapy
  • Massive transfusion
  • Mortality
  • Protocol

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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