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
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