David E Meyer1, Laura E Vincent, Erin E Fox, Terence OʼKeeffe, Kenji Inaba, Eileen Bulger, John B Holcomb, Bryan A Cotton. 1. From the Department of Surgery, Division of Acute Care Surgery, McGovern School of Medicine (D.E.M.), University of Texas Health Sciences Center; The Center for Translational Injury Research (L.E.V., E.E.F.), Houston, Texas; Department of Surgery, Division of Trauma, Critical Care, Burn, and Emergency Surgery, College of Medicine (T.O.K.), University of Arizona, Tucson, Arizona; Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, The Keck School of Medicine (K.I.) Los Angeles County Hospital, Los Angeles, California; Department of Surgery, Division of Trauma, Burn, and Critical Care Surgery, Harborview Medical Center (E.B.), The University of Washington Medical School, Seattle, Washington; and Department of Surgery, Division of Acute Care Surgery McGovern School of Medicine, The Center for Translational Injury Research (J.B.H., B.A.C.), University of Texas Health Sciences Center, Houston, Texas.
Abstract
BACKGROUND:American College of Surgeons Trauma Quality Improvement Best Practices recommends initial massive transfusion (MT) cooler delivery within 15 minutes of protocol activation, with a goal of 10 minutes. The current study sought to examine the impact of timing of first cooler delivery on patient outcomes. METHODS: Patients predicted to receive MT at 12 Level I trauma centers were randomized to two separate transfusion ratios as described in the PROPPR trial. Assessment of Blood Consumption score or clinician gestalt prediction of MT was used to randomize patients and call for initial study cooler. In this planned subanalysis, the time to MT protocol activation and time to delivery of the initial cooler were evaluated. The impact of these times on mortality and time to hemostasis were examined using both Wilcoxon rank sum and linear and logistic regression. RESULTS: Among 680 patients, the median time from patient arrival to MT protocol activation was 9 minutes with a median time from MT activation call to delivery of first cooler of 8 minutes. An increase in both time to MT activation and time to arrival of first cooler were associated with prolonged time to achieving hemostasis (coefficient, 1.09; p = 0.001 and coefficient, 1.16; p < 0.001, respectively). Increased time to MT activation and time to arrival of first cooler were associated with increased mortality (odds ratio [OR], 1.02; p = 0.009 and OR, 1.02; p = 0.012, respectively). Controlling for injury severity, physiology, resuscitation intensity, and treatment arm (1:1:1 vs. 1:1:2), increased time to arrival of first cooler was associated with an increased mortality at 24 hours (OR, 1.05; p = 0.035) and 30 days (OR, 1.05, p = 0.016). CONCLUSION: Delays in MT protocol activation and delays in initial cooler arrival were associated with prolonged time to achieve hemostasis and an increase in mortality. Independent of products ratios, every minute from time of MT protocol activation to time of initial cooler arrival increases odds of mortality by 5%. LEVEL OF EVIDENCE: Prognostic, level II; Therapeutic, level III.
RCT Entities:
BACKGROUND: American College of Surgeons Trauma Quality Improvement Best Practices recommends initial massive transfusion (MT) cooler delivery within 15 minutes of protocol activation, with a goal of 10 minutes. The current study sought to examine the impact of timing of first cooler delivery on patient outcomes. METHODS:Patients predicted to receive MT at 12 Level I trauma centers were randomized to two separate transfusion ratios as described in the PROPPR trial. Assessment of Blood Consumption score or clinician gestalt prediction of MT was used to randomize patients and call for initial study cooler. In this planned subanalysis, the time to MT protocol activation and time to delivery of the initial cooler were evaluated. The impact of these times on mortality and time to hemostasis were examined using both Wilcoxon rank sum and linear and logistic regression. RESULTS: Among 680 patients, the median time from patient arrival to MT protocol activation was 9 minutes with a median time from MT activation call to delivery of first cooler of 8 minutes. An increase in both time to MT activation and time to arrival of first cooler were associated with prolonged time to achieving hemostasis (coefficient, 1.09; p = 0.001 and coefficient, 1.16; p < 0.001, respectively). Increased time to MT activation and time to arrival of first cooler were associated with increased mortality (odds ratio [OR], 1.02; p = 0.009 and OR, 1.02; p = 0.012, respectively). Controlling for injury severity, physiology, resuscitation intensity, and treatment arm (1:1:1 vs. 1:1:2), increased time to arrival of first cooler was associated with an increased mortality at 24 hours (OR, 1.05; p = 0.035) and 30 days (OR, 1.05, p = 0.016). CONCLUSION: Delays in MT protocol activation and delays in initial cooler arrival were associated with prolonged time to achieve hemostasis and an increase in mortality. Independent of products ratios, every minute from time of MT protocol activation to time of initial cooler arrival increases odds of mortality by 5%. LEVEL OF EVIDENCE: Prognostic, level II; Therapeutic, level III.
Authors: John B Holcomb; Barbara C Tilley; Sarah Baraniuk; Erin E Fox; Charles E Wade; Jeanette M Podbielski; Deborah J del Junco; Karen J Brasel; Eileen M Bulger; Rachael A Callcut; Mitchell Jay Cohen; Bryan A Cotton; Timothy C Fabian; Kenji Inaba; Jeffrey D Kerby; Peter Muskat; Terence O'Keeffe; Sandro Rizoli; Bryce R H Robinson; Thomas M Scalea; Martin A Schreiber; Deborah M Stein; Jordan A Weinberg; Jeannie L Callum; John R Hess; Nena Matijevic; Christopher N Miller; Jean-Francois Pittet; David B Hoyt; Gail D Pearson; Brian Leroux; Gerald van Belle Journal: JAMA Date: 2015-02-03 Impact factor: 56.272
Authors: Deborah J Novak; Yu Bai; Rhonda K Cooke; Marisa B Marques; Magali J Fontaine; Jerome L Gottschall; Patricia M Carey; Richard M Scanlan; Eberhard W Fiebig; Ira A Shulman; Janice M Nelson; Sherri Flax; Veda Duncan; Jennifer A Daniel-Johnson; Jeannie L Callum; John B Holcomb; Erin E Fox; Sarah Baraniuk; Barbara C Tilley; Martin A Schreiber; Kenji Inaba; Sandro Rizoli; Jeanette M Podbielski; Bryan A Cotton; John R Hess Journal: Transfusion Date: 2015-03-30 Impact factor: 3.157
Authors: Ronald Chang; Lindley E Folkerson; Duncan Sloan; Jeffrey S Tomasek; Ryan S Kitagawa; H Alex Choi; Charles E Wade; John B Holcomb Journal: Surgery Date: 2016-10-21 Impact factor: 3.982
Authors: Zayde A Radwan; Yu Bai; Nena Matijevic; Deborah J del Junco; James J McCarthy; Charles E Wade; John B Holcomb; Bryan A Cotton Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766
Authors: Sarah Baraniuk; Barbara C Tilley; Deborah J del Junco; Erin E Fox; Gerald van Belle; Charles E Wade; Jeanette M Podbielski; Angela M Beeler; John R Hess; Eileen M Bulger; Martin A Schreiber; Kenji Inaba; Timothy C Fabian; Jeffrey D Kerby; Mitchell Jay Cohen; Christopher N Miller; Sandro Rizoli; Thomas M Scalea; Terence O'Keeffe; Karen J Brasel; Bryan A Cotton; Peter Muskat; John B Holcomb Journal: Injury Date: 2014-06-10 Impact factor: 2.586
Authors: John B Holcomb; Charles E Wade; Joel E Michalek; Gary B Chisholm; Lee Ann Zarzabal; Martin A Schreiber; Ernest A Gonzalez; Gregory J Pomper; Jeremy G Perkins; Phillip C Spinella; Kari L Williams; Myung S Park Journal: Ann Surg Date: 2008-09 Impact factor: 12.969
Authors: John B Holcomb; Deborah J del Junco; Erin E Fox; Charles E Wade; Mitchell J Cohen; Martin A Schreiber; Louis H Alarcon; Yu Bai; Karen J Brasel; Eileen M Bulger; Bryan A Cotton; Nena Matijevic; Peter Muskat; John G Myers; Herb A Phelan; Christopher E White; Jiajie Zhang; Mohammad H Rahbar Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766
Authors: Anthony E Pusateri; Ernest E Moore; Hunter B Moore; Tuan D Le; Francis X Guyette; Michael P Chapman; Angela Sauaia; Arsen Ghasabyan; James Chandler; Kevin McVaney; Joshua B Brown; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herb A Phelan; William R Witham; A Tyler Putnam; Jason L Sperry Journal: JAMA Surg Date: 2020-02-19 Impact factor: 14.766
Authors: Julia R Coleman; Ernest E Moore; Jason M Samuels; Mitchell J Cohen; Angela Sauaia; Joshua J Sumislawski; Arsen Ghasabyan; James G Chandler; Anirban Banerjee; Christopher C Silliman; Erik D Peltz Journal: J Am Coll Surg Date: 2019-01-21 Impact factor: 6.113
Authors: Jeannie L Callum; Calvin H Yeh; Andrew Petrosoniak; Mark J McVey; Stephanie Cope; Troy Thompson; Victoria Chin; Keyvan Karkouti; Avery B Nathens; Kimmo Murto; Suzanne Beno; Jacob Pendergrast; Andrew McDonald; Russell MacDonald; Neill K J Adhikari; Asim Alam; Donald Arnold; Lee Barratt; Andrew Beckett; Sue Brenneman; Hina Razzaq Chaudhry; Allison Collins; Margaret Harvey; Jacinthe Lampron; Clarita Margarido; Amanda McFarlan; Barto Nascimento; Wendy Owens; Menaka Pai; Sandro Rizoli; Theodora Ruijs; Robert Skeate; Teresa Skelton; Michelle Sholzberg; Kelly Syer; Jami-Lynn Viveiros; Josee Theriault; Alan Tinmouth; Rardi Van Heest; Susan White; Michelle Zeller; Katerina Pavenski Journal: CMAJ Open Date: 2019-09-03
Authors: Gregory R Stettler; Joshua J Sumislawski; Ernest E Moore; Geoffrey R Nunns; Lucy Z Kornblith; Amanda S Conroy; Rachael A Callcut; Christopher C Silliman; Anirban Banerjee; Mitchell J Cohen; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2018-10 Impact factor: 3.313
Authors: David E Meyer; Bryan A Cotton; Erin E Fox; Deborah Stein; John B Holcomb; Mitchell Cohen; Kenji Inaba; Elaheh Rahbar Journal: J Trauma Acute Care Surg Date: 2018-10 Impact factor: 3.313