OBJECTIVE: The aim of this study was to identify the effects of recent innovations in trauma major hemorrhage management on outcome and transfusion practice, and to determine the contemporary timings and patterns of death. BACKGROUND: The last 10 years have seen a research-led change in hemorrhage management to damage control resuscitation (DCR), focused on the prevention and treatment of trauma-induced coagulopathy. METHODS: A 10-year retrospective analysis of prospectively collected data of trauma patients who activated the Major Trauma Centre's major hemorrhage protocol (MHP) and received at least 1 unit of red blood cell transfusions (RBC). RESULTS: A total of 1169 trauma patients activated the MHP and received at least 1 unit of RBC, with similar injury and admission physiology characteristics over the decade. Overall mortality declined from 45% in 2008 to 27% in 2017, whereas median RBC transfusion rates dropped from 12 to 4 units (massive transfusion rates from 68% to 24%). The proportion of deaths within 24 hours halved (33%-16%), principally with a fall in mortality between 3 and 24 hours (30%-6%). Survivors are now more likely to be discharged to their own home (57%-73%). Exsanguination is still the principal cause of early deaths, and the mortality associated with massive transfusion remains high (48%). Late deaths are now split between those due to traumatic brain injury (52%) and multiple organ dysfunction (45%). CONCLUSIONS: There have been remarkable reductions in mortality after major trauma hemorrhage in recent years. Mortality rates continue to be high and there remain important opportunities for further improvements in these patients.
OBJECTIVE: The aim of this study was to identify the effects of recent innovations in trauma major hemorrhage management on outcome and transfusion practice, and to determine the contemporary timings and patterns of death. BACKGROUND: The last 10 years have seen a research-led change in hemorrhage management to damage control resuscitation (DCR), focused on the prevention and treatment of trauma-induced coagulopathy. METHODS: A 10-year retrospective analysis of prospectively collected data of trauma patients who activated the Major Trauma Centre's major hemorrhage protocol (MHP) and received at least 1 unit of red blood cell transfusions (RBC). RESULTS: A total of 1169 trauma patients activated the MHP and received at least 1 unit of RBC, with similar injury and admission physiology characteristics over the decade. Overall mortality declined from 45% in 2008 to 27% in 2017, whereas median RBC transfusion rates dropped from 12 to 4 units (massive transfusion rates from 68% to 24%). The proportion of deaths within 24 hours halved (33%-16%), principally with a fall in mortality between 3 and 24 hours (30%-6%). Survivors are now more likely to be discharged to their own home (57%-73%). Exsanguination is still the principal cause of early deaths, and the mortality associated with massive transfusion remains high (48%). Late deaths are now split between those due to traumatic brain injury (52%) and multiple organ dysfunction (45%). CONCLUSIONS: There have been remarkable reductions in mortality after major trauma hemorrhage in recent years. Mortality rates continue to be high and there remain important opportunities for further improvements in these patients.
Authors: Falco Hietbrink; Shahin Mohseni; Diego Mariani; Päl Aksel Naess; Cristina Rey-Valcárcel; Alan Biloslavo; Gary A Bass; Susan I Brundage; Henrique Alexandrino; Ruben Peralta; Luke P H Leenen; Tina Gaarder Journal: Eur J Trauma Emerg Surg Date: 2022-07-07 Impact factor: 2.374
Authors: E Ter Avest; L Carenzo; R A Lendrum; M D Christian; R M Lyon; C Coniglio; M Rehn; D J Lockey; Z B Perkins Journal: Crit Care Date: 2022-06-20 Impact factor: 19.334
Authors: David A C Messerer; Rebecca Halbgebauer; Bo Nilsson; Hermann Pavenstädt; Peter Radermacher; Markus Huber-Lang Journal: Nat Rev Nephrol Date: 2020-09-21 Impact factor: 28.314
Authors: Christina M Theodorou; Laura A Galganski; Gregory J Jurkovich; Diana L Farmer; Shinjiro Hirose; Jacob T Stephenson; A Francois Trappey Journal: J Trauma Acute Care Surg Date: 2021-03-01 Impact factor: 3.697
Authors: K Baksaas-Aasen; L S Gall; J Stensballe; N P Juffermans; N Curry; M Maegele; A Brooks; C Rourke; S Gillespie; J Murphy; R Maroni; P Vulliamy; H H Henriksen; K Holst Pedersen; K M Kolstadbraaten; M R Wirtz; D J B Kleinveld; N Schäfer; S Chinna; R A Davenport; P A Naess; J C Goslings; S Eaglestone; S Stanworth; P I Johansson; C Gaarder; K Brohi Journal: Intensive Care Med Date: 2020-10-13 Impact factor: 17.440