التفاصيل البيبلوغرافية
| العنوان: |
Outcomes after Ultramassive Transfusion in the Modern Era: An EAST Multicenter Study |
| المؤلفون: |
Matthay, Zachary A., Hellmann, Zane J., Callcut, Rachael A., Matthay, Ellicott C., Nunez-Garcia, Brenda, Duong, William, Nahmias, Jeffry, LaRiccia, Aimee K., Spalding, M. Chance, Dalavayi, Satya S., Reynolds, Jessica K., Lesch, Heather, Wong, Yee, Chipman, Amanda, Kozar, Rosemary A., Penaloza, Liz, Mukherjee, Kaushik, Taghlabi, Khaled, Guidry, Christopher A., Seng, Sirivan S., Ratnasekera, Asanthi, Motameni, Amirreza, Udekwu, Pascal, Madden, Kathleen, Moore, Sarah A., Kirsch, Jordan, Goddard, Jesse, Haan, James, Lightwine, Kelly, Ontengco, Julianne B., Cullinane, Daniel C., Spitzer, Sarabeth A., Kubasiak, John C., Gish, Joshua, Hazelton, Joshua P., Byskosh, Alexandria Z., Posluszny, Joseph A., Kornblith, Lucy Z. |
| المصدر: |
J Trauma Acute Care Surg |
| سنة النشر: |
2021 |
| مصطلحات موضوعية: |
Article, demo, envir |
| الوصف: |
BACKGROUND: Despite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (defined as ≥20 units[u] packed red blood cells [RBCs]) in 24 hours[h]) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving ultramassive transfusion in the modern resuscitation era. METHODS: An EAST multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20u RBCs in 24h was performed (2014–2019). Multivariable logistic regression and Classification and Regression Tree analysis (CART) were used to identify clinical characteristics associated with mortality. RESULTS: The 461 patients were young (median age 35 years[y]), male (82%), severely injured (median injury severity score 33), in shock (median shock index 1.2, base excess −9), and were transfused a median of 29u RBCs, 22u of plasma (FFP), and 24u of platelets (PLT). Mortality was 46% at 24h and 65% at discharge. Transfusion of RBC:FFP≥1.5:1 or RBC:PLT≥1.5:1 was significantly associated with mortality, most pronounced for the 18% of patients who received both RBC:PLT and RBC:FFP ≥1.5:1 (odds ratios 3.11 and 2.81 for mortality at 24h and discharge, both p50y, low initial Glasgow Coma Scale, thrombocytopenia, and resuscitative thoracotomy were associated with low likelihood of survival (14–26%), while absence of these factors was associated with the highest survival (71%). CONCLUSIONS: Despite modern massive transfusion protocols, one half of trauma patients receiving ultramassive transfusion are transfused either RBC:FFP or RBC:PLT in unbalanced ratios ≥1.5:1, with increased associated mortality. Maintaining focus on balanced ratios during ultramassive transfusion is critical, and consideration of advanced age, poor initial mental status, thrombocytopenia, and resuscitative thoracotomy can . |
| نوع الوثيقة: |
text |
| اللغة: |
English |
| العلاقة: |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243874Test/ |
| الإتاحة: |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243874Test/ |
| حقوق: |
undefined |
| رقم الانضمام: |
edsbas.60602562 |
| قاعدة البيانات: |
BASE |
