Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study. J Trauma Acute Care Surg 2013 Jul;75(1 Suppl 1):S16-23
Date
08/15/2013Pubmed ID
23778506Pubmed Central ID
PMC3744217DOI
10.1097/TA.0b013e31828fa535Scopus ID
2-s2.0-84880402299 (requires institutional sign-in at Scopus site) 80 CitationsAbstract
BACKGROUND: The classic definition of massive transfusion, 10 or more units of red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available, and may use, during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objective was to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding after injury.
METHODS: Adult patients surviving at least 30 minutes after admission and receiving one or more RBCs within 6 hours of admission from 10 US Level 1 trauma centers were enrolled in the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L = 1 U), colloids (0.5 L = 1 U), and blood products (1 RBC = 1 U, 1 plasma = 1 U, 6 pack platelets = 1 U). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score (RTS), and Injury Severity Score (ISS).
RESULTS: A total of 1,096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products used, the total fluid RI was similar across all sites (3.2 ± 2.5 U). Patients who received four or more units of any resuscitative fluid had a 6-hour mortality rate of 14.4% versus 4.5% in patients who received less than 4 U. The adjusted odds ratio of 6-hour mortality for patients receiving 4 U or more within 30 minutes was 2.1 (95% confidence interval, 1.2-3.5).
CONCLUSION: Resuscitation with four or more units of any fluid was significantly associated with 6-hour mortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness and mortality in severely bleeding patients.
Author List
Rahbar E, Fox EE, del Junco DJ, Harvin JA, Holcomb JB, Wade CE, Schreiber MA, Rahbar MH, Bulger EM, Phelan HA, Brasel KJ, Alarcon LH, Myers JG, Cohen MJ, Muskat P, Cotton BA, PROMMTT Study GroupMESH terms used to index this publication - Major topics in bold
AdultBlood Transfusion
Female
Hemorrhage
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Prospective Studies
Research Design
Resuscitation
Survival Rate
Trauma Centers
Treatment Outcome
United States
Wounds and Injuries
