Is there a limit to massive blood transfusion after severe trauma?

George C. Velmahos, Linda Chan, Michael Chan, Raymond Tatevossian, Edward E. Cornwell, Juan A. Asensio, Thomas V. Berne, Demetrios Demetriades

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)947-952
Number of pages6
JournalArchives of Surgery
Volume133
Issue number9
DOIs
StatePublished - Sep 1998
Externally publishedYes

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Blood Transfusion
Wounds and Injuries
Survivors
Mortality
Emergencies
Medical Futility
Blood Pressure
Trauma Centers
Constriction
Resuscitation
Patient Care
Regression Analysis
Outcome Assessment (Health Care)
Survival
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Velmahos, G. C., Chan, L., Chan, M., Tatevossian, R., Cornwell, E. E., Asensio, J. A., ... Demetriades, D. (1998). Is there a limit to massive blood transfusion after severe trauma? Archives of Surgery, 133(9), 947-952. https://doi.org/10.1001/archsurg.133.9.947

Is there a limit to massive blood transfusion after severe trauma? / Velmahos, George C.; Chan, Linda; Chan, Michael; Tatevossian, Raymond; Cornwell, Edward E.; Asensio, Juan A.; Berne, Thomas V.; Demetriades, Demetrios.

In: Archives of Surgery, Vol. 133, No. 9, 09.1998, p. 947-952.

Research output: Contribution to journalArticle

Velmahos, GC, Chan, L, Chan, M, Tatevossian, R, Cornwell, EE, Asensio, JA, Berne, TV & Demetriades, D 1998, 'Is there a limit to massive blood transfusion after severe trauma?', Archives of Surgery, vol. 133, no. 9, pp. 947-952. https://doi.org/10.1001/archsurg.133.9.947
Velmahos, George C. ; Chan, Linda ; Chan, Michael ; Tatevossian, Raymond ; Cornwell, Edward E. ; Asensio, Juan A. ; Berne, Thomas V. ; Demetriades, Demetrios. / Is there a limit to massive blood transfusion after severe trauma?. In: Archives of Surgery. 1998 ; Vol. 133, No. 9. pp. 947-952.
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