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

被引:5
作者
Kim, Jennie S. S. [1 ]
Casem, Christleen F. F. [2 ]
Baral, Erika [3 ]
Inaba, Kenji [1 ]
Kuza, Catherine M. M. [3 ]
机构
[1] Univ Southern Calif Trauma & Acute Care Surg, Dept Surg, Los Angeles, CA USA
[2] Univ Calif San Francisco East Bay Surg, Dept Surg, Oakland, CA USA
[3] Univ Southern Calif, Dept Anesthesiol, Keck Sch Med, 1450 San Pablo St,Suite 3600, Los Angeles, CA 90033 USA
关键词
MASSIVE BLOOD-TRANSFUSION; EXCEEDING; 50; UNITS; SURVIVAL; PROTOCOL; MORTALITY; VOLUMES; QUALITY; PLASMA; CELLS;
D O I
10.1213/ANE.0000000000006504
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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.
引用
收藏
页码:354 / 364
页数:11
相关论文
共 44 条
  • [1] A Predictive Model for Mortality in Massively Transfused Trauma Patients
    Barbosa, Ronald R.
    Rowell, Susan E.
    Sambasivan, Chitra N.
    Diggs, Brian S.
    Spinella, Philip C.
    Schreiber, Martin A.
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2011, 71 : S370 - S374
  • [2] Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program
    Camazine, Maraya N.
    Hemmila, Mark R.
    Leonard, Julie C.
    Jacobs, Rachel A.
    Horst, Jennifer A.
    Kozar, Rosemary A.
    Bochicchio, Grant V.
    Nathens, Avery B.
    Cryer, Henry M.
    Spinella, Philip C.
    [J]. JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2015, 78 : S48 - S53
  • [3] "Stop the Bleed": A US Military Installation's Model for Implementation of a Rapid Hemorrhage Control Program
    Chambers, James Alan
    Seastedt, Kenneth
    Krell, Robert
    Caterson, Edward
    Levy, Matthew
    Turner, Nancy
    [J]. MILITARY MEDICINE, 2019, 184 (3-4) : 67 - 71
  • [4] Improved survival following massive transfusion in patients who have undergone trauma
    Cinat, ME
    Wallace, WC
    Nastanski, F
    West, J
    Sloan, S
    Ocariz, J
    Wilson, SE
    [J]. ARCHIVES OF SURGERY, 1999, 134 (09) : 964 - 968
  • [5] Damage control hematology: The impact of a trauma exsanguination protocol on survival and blood product utilization
    Cotton, Bryan A.
    Gunter, Oliver L.
    Isbell, James
    Au, Brigham K.
    Robertson, Amy M.
    Morris, John A., Jr.
    Jacques, Paul St.
    Young, Pampee P.
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2008, 64 (05): : 1177 - 1182
  • [6] Predefined Massive Transfusion Protocols are Associated With a Reduction in Organ Failure and Postinjury Complications
    Cotton, Bryan A.
    Au, Brigham K.
    Nunez, Timothy C.
    Gunter, Oliver L.
    Robertson, Amy M.
    Young, Pampee P.
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2009, 66 (01): : 41 - 48
  • [7] Variables predicting trauma patient survival following massive transfusion
    Criddle, LM
    Eldredge, DH
    Walker, J
    [J]. JOURNAL OF EMERGENCY NURSING, 2005, 31 (03) : 236 - 242
  • [8] Triage tool for the rationing of blood for massively bleeding patients during a severe national blood shortage: guidance from the National Blood Transfusion Committee
    Doughty, Heidi
    Green, Laura
    Callum, Jeannie
    Murphy, Michael F.
    [J]. BRITISH JOURNAL OF HAEMATOLOGY, 2020, 191 (03) : 340 - 346
  • [9] Survival after ultramassive transfusion: a review of 1360 cases
    Dzik, Walter Sunny
    Ziman, Alyssa
    Cohen, Claudia
    Pai, Menaka
    Lozano, Miguel
    Kaufman, Richard M.
    Delaney, Meghan
    Selleng, Kathleen
    Murphy, Michael F.
    Hervig, Tor
    Yazer, Mark
    [J]. TRANSFUSION, 2016, 56 (03) : 558 - 563
  • [10] Continued decline in blood collection and transfusion in the United States-2015
    Ellingson, Katherine D.
    Sapiano, Mathew R. P.
    Haass, Kathryn A.
    Savinkina, Alexandra A.
    Baker, Misha L.
    Chung, Koo-Whang
    Henry, Richard A.
    Berger, James J.
    Kuehnert, Matthew J.
    Basavaraju, Sridhar V.
    [J]. TRANSFUSION, 2017, 57 : 1588 - 1598