Effect of Blood Products Transfusion on the Development of Postinjury Multiple Organ Failure

Johnson, Jeffrey L.

doi:10.1001/archsurg.2010.216

Cited by 137 publications

(81 citation statements)

References 42 publications

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“…However, the overall incidence of MOF in trauma patients is higher than that of ARDS, ranging from 15% to 25%, which is three to five times higher than the ARDS incidence. [106][107][108][109] Assuming that the same ratio applies for the incidence in the transfused patients, an estimate of about 45-75% MOF would follow, with a simple average of 60%. However, the only trauma study retrieved on MOF, 109 which reported the transfusion rate, found this rate to be double (45.8%) that of the ARDS study by Chaiwat et al 105 (21%).…”

Section: Complications Related To Trauma And/or Transfusionmentioning

confidence: 99%

“…[106][107][108][109] Assuming that the same ratio applies for the incidence in the transfused patients, an estimate of about 45-75% MOF would follow, with a simple average of 60%. However, the only trauma study retrieved on MOF, 109 which reported the transfusion rate, found this rate to be double (45.8%) that of the ARDS study by Chaiwat et al 105 (21%). Therefore, it might be suggested that an MOF incidence rate of 30% is a more realistic assumption; however, it is clear that this assumption is very uncertain.…”

Section: Complications Related To Trauma And/or Transfusionmentioning

confidence: 99%

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Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Whiting

Westwood

et al. 2015

Health Technol Assess

261

241

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BackgroundPatients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM®Delta, TEM International GmbH, Munich, Germany;www.rotem.de), TEG (TEG®5000 analyser, Haemonetics Corporation, Niles, IL, USA;www.haemonetics.com) and Sonoclot (Sonoclot®coagulation and platelet function analyser, Sienco Inc., Arvada, CO) are point-of-care viscoelastic (VE) devices that use thromboelastometry to test for haemostasis in whole blood. They have a number of proposed advantages over standard laboratory tests (SLTs): they provide a result much quicker, are able to identify what part of the clotting process is disrupted, and provide information on clot formation over time and fibrinolysis.ObjectivesThis assessment aimed to assess the clinical effectiveness and cost-effectiveness of VE devices to assist with the diagnosis, management and monitoring of haemostasis disorders during and after cardiac surgery, trauma-induced coagulopathy and post-partum haemorrhage (PPH).MethodsSixteen databases were searched to December 2013: MEDLINE (OvidSP), MEDLINE In-Process and Other Non-Indexed Citations and Daily Update (OvidSP), EMBASE (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (SCI) (Web of Science), Conference Proceedings Citation Index (CPCI-S) (Web of Science), Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, Latin American and Caribbean Health Sciences Literature (LILACS), International Network of Agencies for Health Technology Assessment (INAHTA), National Institute for Health Research (NIHR) HTA programme, Aggressive Research Intelligence Facility (ARIF), Medion, and the International Prospective Register of Systematic Reviews (PROSPERO). Randomised controlled trials (RCTs) were assessed for quality using the Cochrane Risk of Bias tool. Prediction studies were assessed using QUADAS-2. For RCTs, summary relative risks (RRs) were estimated using random-effects models. Continuous data were summarised narratively. For prediction studies, the odds ratio (OR) was selected as the primary effect estimate. The health-economic analysis considered the costs and quality-adjusted life-years of ROTEM, TEG and Sonoclot compared with SLTs in cardiac surgery and trauma patients. A decision tree was used to take into account short-term complications and longer-term side effects from transfusion. The model assumed a 1-year time horizon.ResultsThirty-one studies (39 publications) were included in the clinical effectiveness review. Eleven RCTs (n = 1089) assessed VE devices in patients undergoing cardiac surgery; six assessed thromboelastography (TEG) and five assessed ROTEM. There was a significant reduction in RBC transfusion [RR 0.88, 95% confidence interval (CI) 0.80 to 0.96; six studies], platelet transfusion (RR 0.72, 95% CI 0.58 to 0.89; six studies) and fresh frozen plasma to transfusion (RR 0.47, 95% CI 0.35 to 0.65; five studies) in VE testing groups compared with control. There were no significant differences between groups in terms of other blood products transfused. Continuous data on blood product use supported these findings. Clinical outcomes did not differ significantly between groups. There were no apparent differences between ROTEM or TEG; none of the RCTs evaluated Sonoclot. There were no data on the clinical effectiveness of VE devices in trauma patients or women with PPH. VE testing was cost-saving and more effective than SLTs. For the cardiac surgery model, the cost-saving was £43 for ROTEM, £79 for TEG and £132 for Sonoclot. For the trauma population, the cost-savings owing to VE testing were more substantial, amounting to per-patient savings of £688 for ROTEM compared with SLTs, £721 for TEG, and £818 for Sonoclot. This finding was entirely dependent on material costs, which are slightly higher for ROTEM. VE testing remained cost-saving following various scenario analyses.ConclusionsVE testing is cost-saving and more effective than SLTs, in both patients undergoing cardiac surgery and trauma patients. However, there were no data on the clinical effectiveness of Sonoclot or of VE devices in trauma patients.Study registrationThis study is registered as PROSPERO CRD42013005623.FundingThe NIHR Health Technology Assessment programme.

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Section: Complications Related To Trauma And/or Transfusionmentioning

confidence: 99%

Section: Complications Related To Trauma And/or Transfusionmentioning

confidence: 99%

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Whiting

Westwood

et al. 2015

Health Technol Assess

261

241

View full text Add to dashboard Cite

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“…Not all investigators agreed and several suggested that increased amounts of plasma and platelets would cause an increase in the incidences of ARDS, TRALI, transfusion-associated circulatory overload, and other bloodrelated complications. 33,34 In an effort to programmatically determine optimal resuscitation practice balancing risk versus benefit, we embarked on a decade-long research effort. The Trauma Outcomes Group collected data from 466 massive transfusion patients from 16 level 1 centers from 2005 to 2006.…”

mentioning

confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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“…Patients receiving more than 6 Units of plasma had a 12-fold increase in ARDS, 6-fold increase in MODS and 4-fold increase in pneumonia and sepsis with non significant improvement in survival. Johnson [11] confirmed these findings, but demonstrated that the deleterious effect associated with plasma transfusion outweighed the survival benefits of plasma only among patients receiving fewer than 6 Units of blood (PRBC). Therefore avoiding plasma transfusion in trauma patients who will not require at least 6 Units of PRBCs might be beneficial.…”

Section: Resultsmentioning

confidence: 93%

“…In Italy the recent introduction of pathogen-inactivated plasma enabled to further minimize the risks of TRALI and virtually eliminate the risks of transmission of infective diseases. Although these measures are effective in reducing some of the adverse effects of plasma transfusions, recent data [11] show that in patients who require less than 6 Units of PRBCs, the complications related to plasma transfusion may overcome the benefits.…”

Section: Introductionmentioning

confidence: 99%

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

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In recent years, a strong focus has been put on the need to assure early coagulation support in order to prevent and treat coagulopathy in patients with severe trauma, and to improve survival. Aggressive plasma administration with high plasma/ red blood cells ratio is increasingly used worldwide. However, plasma transfusion is associated with increased risks of multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS) and infection, which may prolong hospital stay and the need for artificial ventilation. Moreover, in the majority of European hospitals plasma cannot be immediately available and therefore it has been reported a significant delay in coagulation support. This has lead to the proposal of using clotting factors as an alternative to plasma. However, strong evidence to define the best strategy is still missing, and the only published protocols are Institution-specific, thus depending on the local organization and the available resources. The Italian Trauma Centers Network (TUN) recently developed a treatment protocol aiming at shortening the interval before the onset of coagulation support and at reducing the use of plasma. We present this protocol-Early Coagulation Support (ECS) Protocol -and discuss its rationale. Its implications for the trauma-team workflow and hospital organization are also addressed. The ECS protocol must be considered as an integrated part of a comprehensive Damage Control Strategy. The impact of the ECS Protocol on blood products consumption, trauma mortality and morbidity as well as its financial aspects, will be strictly monitored by the TUN hospitals.

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Effect of Blood Products Transfusion on the Development of Postinjury Multiple Organ Failure

Cited by 137 publications

References 42 publications

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

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