Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society

Abstract

Massive blood transfusion is one main prognostic factor for mortality in trauma. Although MBT is generally considered to be critical, every second trauma patient with MBT survived. A cut-off value for the number of PRBC could not be determined. Extended transfusion management even with high amounts of PRBC seems to be justified.

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

“…Overall, our data suggest that early massive transfusion is associated with worse organ dysfunction in the ICU, but not increased early mortality or hospital mortality among those surviving initial resuscitation. In contrast, other studies in traumatically injured patients have found an independent association of red blood cell transfusion on mortality, 10,[17][18][19][20]26 with most hemorrhage-related deaths occurring within 24 hr of trauma. 4 This association has been described in patients with primarily blunt trauma 10,19 and in mixed populations with *20% penetrating trauma.…”

“…In contrast, other studies in traumatically injured patients have found an independent association of red blood cell transfusion on mortality, 10,[17][18][19][20]26 with most hemorrhage-related deaths occurring within 24 hr of trauma. 4 This association has been described in patients with primarily blunt trauma 10,19 and in mixed populations with *20% penetrating trauma. 17,18,20 These studies have also demonstrated patient age and severity of injury and illness to predict hospital mortality, raising the possibility 21 HR \ 1 implies a decreased relative hazard of live ICU discharge, that is, a longer ICU stay among survivors as the value of the predictor variable increases.…”

“…The statistical significance of the latter finding depended on whether patients with missing data on the number of red blood cell units transfused were included with imputed values or simply dropped, although the absolute effect was similar and extremely small in magnitude in both analyses. Potential causes of delayed morbidity include acute lung injury, 6,7 infection, [8][9][10] and multiple organ failure 10,11 mediated by pro-inflammatory effects of leukocytes. 29 We found several other noteworthy associations.…”

“…3 Among traumatically injured patients, those with massive hemorrhage account for 80% of early mortality 4 and 40% of in-hospital mortality. 5 Transfusion of red blood cells in trauma patients has also been associated with acute lung injury, 6,7 infection, [8][9][10] and multiple organ failure. 10,11 To inform local hospital efforts to standardize transfusion practices for trauma patients, we designed a quality improvement project to describe the effects of early transfusion practices for massively bleeding trauma patients.…”

“…5 Transfusion of red blood cells in trauma patients has also been associated with acute lung injury, 6,7 infection, [8][9][10] and multiple organ failure. 10,11 To inform local hospital efforts to standardize transfusion practices for trauma patients, we designed a quality improvement project to describe the effects of early transfusion practices for massively bleeding trauma patients. We examined the independent association linking red blood cell transfusion volume before 48 hr and (1) organ dysfunction (primary outcome), as defined by the sequential organ failure assessment (SOFA) score 12 ; (2) hospital mortality; (3) length of stay in the intensive care unit (ICU) (all among patients surviving the initial 48 hr); and (4) 48-hr mortality among all patients.…”