BACKGROUND: Early prediction of the need for massive transfusion (MT) remains difficult. We hypothesized that MT protocol (MTP) utilization would improve by identifying markers for MT (>10 units packed red blood cell [PRBC] in 24 hours) in torso gunshot wounds (GSW) requiring early transfusion and operation. METHODS: Data from all MTPs were collected prospectively from February 1, 2007, to January 31, 2009. Demographic, transfusion, anatomic, and operative data were analyzed for MT predictors. RESULTS: Of the 216 MTP activations, 78 (36%) patients sustained torso GSW requiring early transfusion and operation. Five were moribund and died before receiving MT. Of 73 early survivors, 56 received MT (76%, mean 19 units PRBC) and 17 had early bleeding control (EBC), (24%, mean 5 units PRBC). Twelve transpelvic and 13 multicavitary wounds all received MT regardless of initial hemodynamic status (mean systolic blood pressure: 96 mm Hg; range, 50-169). Of 31 MT patients with low-risk trajectories (LRT), 18 (58%) had a systolic blood pressure <90 mm Hg compared with 3 of 17 (17%) in the EBC group (p < 0.01). In these same groups, a base deficit of <-10 was present in 27 of 31 (92%) MT patients versus 4 of 17 (23%) EBC patients (p < 0.01). The presence of both markers identified 97% of patients with LRT who requiring MT and their absence would have potentially eliminated 16 of 17 EBC patients from MTP activation. CONCLUSIONS: In patients requiring early operation and transfusion after torso GSW: (1) early initiation of MTP is reasonable for transpelvic and multicavitary trajectories regardless of initial hemodynamic status as multiple or difficult to control bleeding sources are likely and (2) early initiation of MTP in patients with LRT may be guided by a combination of hypotension and acidosis, indicating massive blood loss.
BACKGROUND: Early prediction of the need for massive transfusion (MT) remains difficult. We hypothesized that MT protocol (MTP) utilization would improve by identifying markers for MT (>10 units packed red blood cell [PRBC] in 24 hours) in torso gunshot wounds (GSW) requiring early transfusion and operation. METHODS: Data from all MTPs were collected prospectively from February 1, 2007, to January 31, 2009. Demographic, transfusion, anatomic, and operative data were analyzed for MT predictors. RESULTS: Of the 216 MTP activations, 78 (36%) patients sustained torso GSW requiring early transfusion and operation. Five were moribund and died before receiving MT. Of 73 early survivors, 56 received MT (76%, mean 19 units PRBC) and 17 had early bleeding control (EBC), (24%, mean 5 units PRBC). Twelve transpelvic and 13 multicavitary wounds all received MT regardless of initial hemodynamic status (mean systolic blood pressure: 96 mm Hg; range, 50-169). Of 31 MT patients with low-risk trajectories (LRT), 18 (58%) had a systolic blood pressure <90 mm Hg compared with 3 of 17 (17%) in the EBC group (p < 0.01). In these same groups, a base deficit of <-10 was present in 27 of 31 (92%) MT patients versus 4 of 17 (23%) EBCpatients (p < 0.01). The presence of both markers identified 97% of patients with LRT who requiring MT and their absence would have potentially eliminated 16 of 17 EBCpatients from MTP activation. CONCLUSIONS: In patients requiring early operation and transfusion after torso GSW: (1) early initiation of MTP is reasonable for transpelvic and multicavitary trajectories regardless of initial hemodynamic status as multiple or difficult to control bleeding sources are likely and (2) early initiation of MTP in patients with LRT may be guided by a combination of hypotension and acidosis, indicating massive blood loss.
Authors: E I Hodgman; M W Cripps; M J Mina; E M Bulger; M A Schreiber; K J Brasel; M J Cohen; P Muskat; J G Myers; L H Alarcon; M H Rahbar; J B Holcomb; B A Cotton; E E Fox; D J Del Junco; C E Wade; H A Phelan Journal: J Trauma Acute Care Surg Date: 2018-02 Impact factor: 3.313
Authors: Rachael A Callcut; Bryan A Cotton; Peter Muskat; Erin E Fox; Charles E Wade; John B Holcomb; Martin A Schreiber; Mohammad H Rahbar; Mitchell J Cohen; M Margaret Knudson; Karen J Brasel; Eileen M Bulger; Deborah J Del Junco; John G Myers; Louis H Alarcon; Bryce R H Robinson Journal: J Trauma Acute Care Surg Date: 2013-01 Impact factor: 3.313
Authors: Erica I Hodgman; Bryan C Morse; Christopher J Dente; Michael J Mina; Beth H Shaz; Jeffrey M Nicholas; Amy D Wyrzykowski; Jeffrey P Salomone; Grace S Rozycki; David V Feliciano Journal: J Trauma Acute Care Surg Date: 2012-04 Impact factor: 3.313
Authors: Ruth S Hwu; Philip C Spinella; Martin S Keller; David Baker; Michael Wallendorf; Julie C Leonard Journal: Transfusion Date: 2016-08-29 Impact factor: 3.157
Authors: Ruchika Goel; Xianming Zhu; Sarah Makhani; Molly R Petersen; Cassandra D Josephson; Louis M Katz; Beth H Shaz; Richard Austin; Elizabeth P Crowe; Paul M Ness; Eric A Gehrie; Steven M Frank; Evan M Bloch; Aaron A R Tobian Journal: Transfusion Date: 2021-07-02 Impact factor: 3.337