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

被引:229
作者
Dente, Christopher J. [1 ]
Shaz, Beth H. [2 ]
Nicholas, Jeffery M. [1 ]
Harris, Robert S. [3 ]
Wyrzykowski, Amy D. [1 ]
Patel, Snehal [1 ]
Shah, Amit [1 ]
Vercruysse, Gat A. [1 ]
Feliciano, David V. [1 ]
Rozycki, Grace S. [1 ]
Salomone, Jeffrey P. [1 ]
Ingram, Walter L. [1 ]
机构
[1] Grady Mem Hosp, Dept Surg, Atlanta, GA USA
[2] Grady Mem Hosp, Dept Pathol & Lab Med, Atlanta, GA USA
[3] Grady Mem Hosp, Dept Anesthesiol, Atlanta, GA USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2009年 / 66卷 / 06期
关键词
Massive transfusion; Protocol; Component therapy; Mortality; Coagulopathy after trauma; DAMAGE CONTROL RESUSCITATION; COMBAT CASUALTIES; IMPROVED SURVIVAL; COAGULATION; INJURY; IMPACT; HEMORRHAGE; DIAGNOSIS; SURGERY; THERAPY;
D O I
10.1097/TA.0b013e3181a59ad5
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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 (preMTP) 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 drasticatly 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.
引用
收藏
页码:1616 / 1624
页数:9
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