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

Research output: Contribution to journalArticle

89 Citations (Scopus)

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
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Hemoglobins
Oxygen
Wounds and Injuries
Trauma Centers
Exsanguination
Multiple Organ Failure
Near-Infrared Spectroscopy
Validation Studies
ROC Curve
Survivors
Epidemiology
Hospitalization
Erythrocytes
Logistic Models
Hemorrhage
Morbidity
Mortality

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

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

In: Journal of Trauma, Vol. 64, No. 4, 04.2008, p. 1010-1023.

Research output: Contribution to journalArticle

Moore, FA, Nelson, T, McKinley, BA, Moore, EE, Nathens, AB, Rhee, PM, Puyana, JC, Beilman, GJ, Cohn, SM, McCarthy, J, Jonas, RB, Johnston, J, Lopez, P, Nathen, AB, Nuxoll, D, Tang, H, Sangthong, B, Constantinou, C, Polanco, P, Peitzman, AB, Huls, S, Johnson, JL, Cothren, CC, Thorson, M, Beal, A, Ronald, GP, Gentilello, LM, Meyer, AA, Anderson, L, Gallea, B, Rupp, D, Saar, B, McGraw, M, Diaz, VA, Carlson, K & Wheatley, G 2008, 'Massive transfusion in trauma patients: Tissue hemoglobin oxygen saturation predicts poor outcome', Journal of Trauma, vol. 64, no. 4, pp. 1010-1023. https://doi.org/10.1097/TA.0b013e31816a2417
Moore, Frederick A. ; Nelson, Teresa ; McKinley, Bruce A. ; Moore, Ernest E. ; Nathens, Avery B. ; Rhee, Peter M ; Puyana, Juan Carlos ; Beilman, Gregory J. ; Cohn, Stephen M. ; McCarthy, Janet ; Jonas, Rachelle Babbitt ; Johnston, Joseph ; Lopez, Peter ; Nathen, Avery B. ; Nuxoll, Dian ; Tang, Huawei ; Sangthong, Burapat ; Constantinou, Constantinos ; Polanco, Patricio ; Peitzman, Andrew B. ; Huls, Stephanie ; Johnson, Jeffrey L. ; Cothren, Catherine C. ; Thorson, Melissa ; Beal, Alan ; Ronald, G. Pearl ; Gentilello, Larry M. ; Meyer, Anthony A. ; Anderson, Leann ; Gallea, Barbara ; Rupp, Diane ; Saar, Becky ; McGraw, Michelle ; Diaz, V. A. ; Carlson, Kristi ; Wheatley, Greg. / Massive transfusion in trauma patients : Tissue hemoglobin oxygen saturation predicts poor outcome. In: Journal of Trauma. 2008 ; Vol. 64, No. 4. pp. 1010-1023.
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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.",
keywords = "Coagulopathy, Massive transfusion, Multiple organ dysfunction, Near infrared spectrometry, NIR, NIRS, Shock, StO, Tissue hemoglobin oxygen saturation, Trauma",
author = "Moore, {Frederick A.} and Teresa Nelson and McKinley, {Bruce A.} and Moore, {Ernest E.} and Nathens, {Avery B.} and Rhee, {Peter M} and Puyana, {Juan Carlos} and Beilman, {Gregory J.} and Cohn, {Stephen M.} and Janet McCarthy and Jonas, {Rachelle Babbitt} and Joseph Johnston and Peter Lopez and Nathen, {Avery B.} and Dian Nuxoll and Huawei Tang and Burapat Sangthong and Constantinos Constantinou and Patricio Polanco and Peitzman, {Andrew B.} and Stephanie Huls and Johnson, {Jeffrey L.} and Cothren, {Catherine C.} and Melissa Thorson and Alan Beal and Ronald, {G. Pearl} and Gentilello, {Larry M.} and Meyer, {Anthony A.} and Leann Anderson and Barbara Gallea and Diane Rupp and Becky Saar and Michelle McGraw and Diaz, {V. A.} and Kristi Carlson and Greg Wheatley",
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TY - JOUR

T1 - Massive transfusion in trauma patients

T2 - Tissue hemoglobin oxygen saturation predicts poor outcome

AU - Moore, Frederick A.

AU - Nelson, Teresa

AU - McKinley, Bruce A.

AU - Moore, Ernest E.

AU - Nathens, Avery B.

AU - Rhee, Peter M

AU - Puyana, Juan Carlos

AU - Beilman, Gregory J.

AU - Cohn, Stephen M.

AU - McCarthy, Janet

AU - Jonas, Rachelle Babbitt

AU - Johnston, Joseph

AU - Lopez, Peter

AU - Nathen, Avery B.

AU - Nuxoll, Dian

AU - Tang, Huawei

AU - Sangthong, Burapat

AU - Constantinou, Constantinos

AU - Polanco, Patricio

AU - Peitzman, Andrew B.

AU - Huls, Stephanie

AU - Johnson, Jeffrey L.

AU - Cothren, Catherine C.

AU - Thorson, Melissa

AU - Beal, Alan

AU - Ronald, G. Pearl

AU - Gentilello, Larry M.

AU - Meyer, Anthony A.

AU - Anderson, Leann

AU - Gallea, Barbara

AU - Rupp, Diane

AU - Saar, Becky

AU - McGraw, Michelle

AU - Diaz, V. A.

AU - Carlson, Kristi

AU - Wheatley, Greg

PY - 2008/4

Y1 - 2008/4

N2 - 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.

AB - 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.

KW - Coagulopathy

KW - Massive transfusion

KW - Multiple organ dysfunction

KW - Near infrared spectrometry

KW - NIR

KW - NIRS

KW - Shock

KW - StO

KW - Tissue hemoglobin oxygen saturation

KW - Trauma

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