Massive transfusion in trauma patients: Tissue hemoglobin oxygen saturation predicts poor outcome

Frederick A. Moore, Teresa Nelson, Bruce A. McKinley, Ernest E. Moore, Avery B. Nathens, Peter M Rhee, Juan Carlos Puyana, Gregory J. Beilman, Stephen M. Cohn, Janet McCarthy, Rachelle Babbitt Jonas, Joseph Johnston, Peter Lopez, Avery B. Nathen, Dian Nuxoll, Huawei Tang, Burapat Sangthong, Constantinos Constantinou, Patricio Polanco, Andrew B. PeitzmanStephanie Huls, Jeffrey L. Johnson, Catherine C. Cothren, Melissa Thorson, Alan Beal, G. Pearl Ronald, Larry M. Gentilello, Anthony A. Meyer, Leann Anderson, Barbara Gallea, Diane Rupp, Becky Saar, Michelle McGraw, V. A. Diaz, Kristi Carlson, Greg Wheatley

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91 Scopus citations

Abstract

BACKGROUND: Severely bleeding trauma patients requiring massive transfusion (MT) often experience poor outcomes. Our purpose was to determine the potential role of near infrared spectrometry derived tissue hemoglobin oxygen saturation (StO2) monitoring in early prediction of MT, and in the identification of those MT patients who will have poor outcomes. METHODS: Data from a prospective multi-institution StO2 monitoring study were analyzed to determine the current epidemiology of MT (defined as transfusion volume ≥10 units packed red blood cells in 24 hours of hospitalization). Multivariate logistic regression was used to develop prediction models. RESULTS: Seven US level I trauma centers (TC) enrolled 383 patients. 114 (30%) required MT. MT progressed rapidly (40% exceeded MT threshold 2 hours after TC arrival, 80% after 6 hours). One third of MT patients died. Two thirds of deaths were due to early exsanguination and two thirds of early exsanguination patients died within 6 hours. One third of the early MT survivors developed multiple organ dysfunction syndrome. MT could be predicted with standard, readily available clinical data within 30 minutes and 60 minutes of TC arrival (area under the receiver operating characteristic curve = 0.78 and 0.80). In patients who required MT, StO2 was the only consistent predictor of poor outcome (multiple organ dysfunction syndrome or death). CONCLUSION: MT progresses rapidly to significant morbidity and mortality despite level I TC care. Patients who require MT can be predicted early, and persistent low StO2 identifies those MT patients destined to have poor outcome. The ultimate goal is to identify these high risk patients as early as possible to test new strategies to improve outcome. Further validation studies are needed to analyze appropriate allocation and study appropriate use of damage control interventions.

Original languageEnglish (US)
Pages (from-to)1010-1023
Number of pages14
JournalJournal of Trauma
Volume64
Issue number4
DOIs
Publication statusPublished - Apr 2008
Externally publishedYes

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Keywords

  • Coagulopathy
  • Massive transfusion
  • Multiple organ dysfunction
  • Near infrared spectrometry
  • NIR
  • NIRS
  • Shock
  • StO
  • Tissue hemoglobin oxygen saturation
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Moore, F. A., Nelson, T., McKinley, B. A., Moore, E. E., Nathens, A. B., Rhee, P. M., ... Wheatley, G. (2008). Massive transfusion in trauma patients: Tissue hemoglobin oxygen saturation predicts poor outcome. Journal of Trauma, 64(4), 1010-1023. https://doi.org/10.1097/TA.0b013e31816a2417