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

• Published in: Canadian journal of anesthesia Vol. 56; no. 10; pp. 740 - 750
• Main Authors: Mahambrey, Tushar D., Fowler, Robert A., Pinto, Ruxandra, Smith, Terry S., Callum, Jeannie L., Pisani, Nagib S., Rizoli, Sandro B., Adhikari, Neill K. J.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-10-2009; Springer; Springer Nature B.V
• Subjects: Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Blood; Blood Transfusion - mortality; Blood Transfusion - statistics & numerical data; Canada; Cardiology; Clinical outcomes; Cohort analysis; Cohort Studies; Critical Care; Critical Care Medicine; Data Collection; Erythrocyte Transfusion - mortality; Erythrocyte Transfusion - statistics & numerical data; Female; Health sciences; Hospital Mortality; Hospitals; Humans; Injuries; Intensive; Length of Stay; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multiple organ dysfunction syndrome; Multiple Organ Failure - mortality; Multiple Organ Failure - prevention & control; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Reports of Original Investigations; Retrospective Studies; Sample Size; Socioeconomic Factors; Survival Analysis; Trauma; Treatment Outcome; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Canada; Hospital Mortality; Intensive Care Unit Stay; Intensive Care Unit Admission; Sequential Organ Failure Assessment; Injury Severity Score; Human; Anesthesia; Transfusion; Trauma; Cohort study
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-009-9151-5

Purpose
To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients.
Methods
A retrospective cohort study (1992–2001) including 260 patients receiving ≥10 RBC units ≤24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes.
Results
Patients had a high (mean [standard deviation]) injury severity score (ISS) (42.5 [15.1]), a high admission sequential organ failure assessment (SOFA) score (8.4 [3.8]), and a high hospital mortality (58.5%). They received 38 (25–64) (median [interquartile range]) blood components within 48 hr, including 19 (14–28) RBC units. For 143 patients surviving ≥48 hr, the maximum SOFA score was associated with RBC units transfused before 48 hr (linear regression beta coefficient 0.075,
P
 < 0.0001), lower nadir hemoglobin before 48 hr (0.034,
P
 = 0.03), age (0.032,
P
 = 0.015), and admission SOFA (0.59,
P
 < 0.0001). The RBC units transfused by 48 hr were not associated with either hospital mortality (
n
 = 35) among patients surviving ≥48 hr (independent predictors, age [logistic regression odds ratio (OR) 1.06, 95% confidence interval 1.03–1.10], ISS [OR 1.07, 1.02–1.13], and maximum SOFA score [OR 1.56, 1.27–1.93]) or 48-hr mortality (
n
 = 117) (independent predictors, admission SOFA [1.65, 1.45–1.88] and later year of hospital admission [OR 1.15, 1.02–1.29]).
Conclusions
Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion.