Massive transfusion exceeding 50 units of blood products in trauma patients

Massive transfusion of blood products in trauma patients can acutely deplete the blood bank. It was hypothesized that, despite a large allocation of resources to trauma patients receiving more than 50 units of blood products in the first 24 hours, outcome data would support the continued practice of massive transfusion.

A retrospective review of charts and registry data of trauma patients who received over 50 units of blood products in the first day was conducted for a 5-year period at a Level I trauma center. Patients were stratified into groups on the basis of the number of transfusions received. Results are expressed as mean +/- SD. Univariate analysis and multivariate logistic regression were used to identify those risk factors determined in the first 24 hours after admission that were predictive of mortality. Physiologic differences between survivors and nonsurvivors were also examined.

Of 7,734 trauma patients admitted between July 1, 1995, and June 30, 2000, 44 (0.6%) received > 50 units of blood products in the first day. Overall mortality in these patients was 57%. There was no significant difference (p = 0.565, chi2) in mortality rate between patients who received > 75 units of blood products in the first day versus those who received 51 to 75 units. Multiple logistic regression analysis identified only one independent risk factor, base deficit > 12 mmol/L, associated with mortality. Base deficit > 12 mmol/L increases the risk of death by 5.5 times (p = 0.013; 95% confidence interval, 1.44-20.95). Neither the total blood product transfusion requirement in the first day nor the packed red blood cell transfusion amount in the first day were significant independent risk factors. Causes of the 25 deaths in this series included exsanguination in the operating room (n = 1) or in the surgical intensive care unit (n = 12), multiple organ failure/sepsis (n = 3), head injury (n = 3), respiratory failure (n = 2), cerebrovascular accident (n = 1), and other (n = 3). Of the survivors, 63% were discharged to home, 21% to rehabilitation, 11% to nursing home, and 5% to another acute care facility. Of the nonsurvivors, the mean Injury Severity Score was 43, 88% had a base deficit > 12 mmol/L, 68% had a Glasgow Coma Scale score < 8, and 64% had a Sequential Organ Failure Assessment score > 10.

The 43% survival rate in trauma patients receiving > 50 units of blood products warrants continued aggressive transfusion therapy in the first 24 hours after admission.