TY - JOUR
T1 - Is there a limit to massive blood transfusion after severe trauma?
AU - Velmahos, George C.
AU - Chan, Linda
AU - Chan, Michael
AU - Tatevossian, Raymond
AU - Cornwell, Edward E.
AU - Asensio, Juan A.
AU - Berne, Thomas V.
AU - Demetriades, Demetrios
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1998/9
Y1 - 1998/9
N2 - Objective: To examine the hypothesis that the futility of short-term care for trauma patients requiring emergency operation can be determined based on the number of units of blood transfused and associated risk factors. Design: A 4-year retrospective review of a cohort of critically injured patients who underwent an emergency operation. Setting: A large-volume, academic level I, urban trauma center. Patients: One hundred forty-one consecutive patients received massive blood transfusions of 20 U or more of blood during preoperative and intraoperative resuscitation (highest, 68 U). There were 43 survivors (30.5%) and 98 nonsurvivors (69.5%). Main Outcome Measures: Mortality. Results: The number of blood units transfused did not differ between survivors and nonsurvivors (mean ± SD, 31 ± 11 vs 32 ± 10; P = .52). Stepwise multiple regression analysis identified 3 independent variables associated with mortality: need for aortic clamping, intraoperative use of inotropes, and intraoperative time with a systolic blood pressure of 90 mm Hg or less. However, blood usage was not different among the subgroups of patients who had 1 or more of these risk factors. When patients were stratified according to the amount of massive blood transfusion (20-29, 30- 39, 40-49, and 50-68 U), the incidence of risk factors was not different across the 4 subgroups. Survival in the presence of risk factors was not affected by the amount of blood transfused. Conclusions: Although mortality among critically injured patients requiring operation and massive blood transfusion can be correlated with independent risk factors, discontinuation of short-term care cannot be justified based on the need for massive blood transfusion of up to 68 units.
AB - Objective: To examine the hypothesis that the futility of short-term care for trauma patients requiring emergency operation can be determined based on the number of units of blood transfused and associated risk factors. Design: A 4-year retrospective review of a cohort of critically injured patients who underwent an emergency operation. Setting: A large-volume, academic level I, urban trauma center. Patients: One hundred forty-one consecutive patients received massive blood transfusions of 20 U or more of blood during preoperative and intraoperative resuscitation (highest, 68 U). There were 43 survivors (30.5%) and 98 nonsurvivors (69.5%). Main Outcome Measures: Mortality. Results: The number of blood units transfused did not differ between survivors and nonsurvivors (mean ± SD, 31 ± 11 vs 32 ± 10; P = .52). Stepwise multiple regression analysis identified 3 independent variables associated with mortality: need for aortic clamping, intraoperative use of inotropes, and intraoperative time with a systolic blood pressure of 90 mm Hg or less. However, blood usage was not different among the subgroups of patients who had 1 or more of these risk factors. When patients were stratified according to the amount of massive blood transfusion (20-29, 30- 39, 40-49, and 50-68 U), the incidence of risk factors was not different across the 4 subgroups. Survival in the presence of risk factors was not affected by the amount of blood transfused. Conclusions: Although mortality among critically injured patients requiring operation and massive blood transfusion can be correlated with independent risk factors, discontinuation of short-term care cannot be justified based on the need for massive blood transfusion of up to 68 units.
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U2 - 10.1001/archsurg.133.9.947
DO - 10.1001/archsurg.133.9.947
M3 - Article
C2 - 9749845
AN - SCOPUS:0031691176
VL - 133
SP - 947
EP - 952
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 9
ER -