When is enough enough? Odds of survival by unit transfused

Loudon, Andrew M.; Rushing, Amy P.; Hue, Jonathan J.; Ziemak, Alison; Sarode, Anuja L.; Moorman, Matthew L.

doi:10.1097/ta.0000000000003835

Cited by 19 publications

(41 citation statements)

References 33 publications

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“…The reported mortality rates for trauma patients receiving UMT ranged from 29% to 69%. 6,7,13,14,[26][27][28][29][30][31][32][33][34][35] Most studies examining UMT in trauma patients did not appear to support a cutoff value of blood products based on mortality rates, 6,7,13,14,[26][27][28][29][30][31][33][34][35] although there was a trend toward increased mortality as the number of blood products transfused increased. 6,7,13,32 Several studies have demonstrated that trauma patients who receive >35 to 40 units of RBC significantly increase mortality rates, 7,32,38 with one suggesting 100% mortality after 67 units RBC.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,13,14,[26][27][28][29][30][31][32][33][34][35] Most studies examining UMT in trauma patients did not appear to support a cutoff value of blood products based on mortality rates, 6,7,13,14,[26][27][28][29][30][31][33][34][35] although there was a trend toward increased mortality as the number of blood products transfused increased. 6,7,13,32 Several studies have demonstrated that trauma patients who receive >35 to 40 units of RBC significantly increase mortality rates, 7,32,38 with one suggesting 100% mortality after 67 units RBC. 32 The largest study-to-date was performed by Gallastegi et al, which analyzed UMT recipients found in the national trauma database, did not demonstrate a direct correlation between the volume of blood transfused at either 4 or 24 hours and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Yu et al 6 used the term supermassive transfusion for ≥25 units of RBC over a 24-hour period. Seven of the 14 studies used 20 units of blood as their inclusion criteria, whether it was RBC, whole blood, or other blood products such as FFP or PLT, 13,14,26,28,32,33,35 and the remaining studies used 21 units, 34 25 units, 6 30 units, 7 40 units, 27 or 50 units. [29][30][31] Mortality Rates Patient mortality ranged from 29% to 69%.…”

Section: Umt Definitionmentioning

confidence: 99%

“…Loudon et al 32 performed a retrospective study from a single level I trauma center's registry over a 3-year period with the goal of defining the odds of survival during a balanced resuscitation to determine the point at which mortality exceeds survival. On multivariable logistic regression, each unit RBC transfused was associated with an increased likelihood of mortality.…”

Section: Factors Associated With Increased Mortalitymentioning

confidence: 99%

“…Survival approached zero after 36 units RBC (OR, 0.09; 95% CI, 0.0-0.56, at 37 units), and no patient survived after 67 units RBC in their series. 32…”

Section: Author Yearmentioning

confidence: 99%

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Narrative Review: Is There a Transfusion Cutoff Value After Which Nonsurvivability Is Inevitable in Trauma Patients Receiving Ultramassive Transfusion?

Kim

Casem

Baral

et al. 2023

Anesthesia &Amp; Analgesia

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The institution of massive transfusion protocols (MTPs) has improved the timely delivery of large quantities of blood products and improves patient outcomes. In recent years, the cost of blood products has increased, compounded by significant blood product shortages. There is practical need for identification of a transfusion volume in trauma patients that is associated with increased mortality, or a threshold after which additional transfusion is futile and associated with nonsurvivability. This transfusion threshold is often described in the setting of an ultramassive transfusion (UMT). There are few studies defining what constitutes amount or outcomes associated with such large volume transfusion. The purpose of this narrative review is to provide an analysis of existing literature examining the effects of UMT on outcomes including survival in adult trauma patients and to determine whether there is a threshold transfusion limit after which mortality is inevitable. Fourteen studies were included in this review. The data examining the utility of UMT in trauma are of poor quality, and with the variability inherent in trauma patients, and the surgeons caring for them, no universally accepted cutoff for transfusion exists. Not surprisingly, there is a trend toward increasing mortality with increasing transfusions. The decision to continue transfusing is multifactorial and must be individualized, taking into consideration patient characteristics, institution factors, blood bank supply, and most importantly, constant reevaluation of the need for ongoing transfusion rather than blind continuous transfusion until the heart stops.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Umt Definitionmentioning

confidence: 99%

Section: Factors Associated With Increased Mortalitymentioning

confidence: 99%

“…Survival approached zero after 36 units RBC (OR, 0.09; 95% CI, 0.0-0.56, at 37 units), and no patient survived after 67 units RBC in their series. 32…”

Section: Author Yearmentioning

confidence: 99%

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