Massive Blood Transfusion in Patients with Ruptured Abdominal Aortic Aneurysm

Area of Science:

• Vascular Surgery
• Transfusion Medicine
• Critical Care Medicine

Background:

• Ruptured abdominal aortic aneurysms (rAAAs) are associated with high mortality and often necessitate massive transfusion (MT).
• Understanding blood product ratios is crucial for optimizing outcomes in these critically ill patients.

Purpose of the Study:

• To investigate blood transfusion practices and product ratios in patients with rAAAs requiring MT.
• To determine the association between blood product ratios and 30-day mortality in rAAA patients.

Main Methods:

• A registry-based cohort study included 369 rAAA patients from 2008-2013.
• Massive transfusion was defined as ≥10 red blood cell (RBC) units within 24 hours.
• Logistic regression analyzed the association between blood product ratios (FFP/RBC, PLT/RBC) and 30-day mortality.

Main Results:

• 261 patients (71%) required MT, with endovascular aneurysm repair (EVAR) patients receiving fewer RBC, FFP, and PLT units compared to open repair (OR) patients.
• MT patients undergoing EVAR had lower FFP/RBC (0.59) and PLT/RBC (0) ratios than OR patients (0.84 and 0.12, respectively).
• A FFP/RBC ratio near 1:1 was associated with reduced 30-day mortality in OR patients. The PLT/RBC ratio increased over time.

Conclusions:

• EVAR patients with rAAA and MT generally received lower ratios of FFP and PLTs compared to OR patients.
• A FFP/RBC ratio close to 1:1 may improve survival in open repair patients with rAAA requiring MT.
• Transfusion strategies and product ratios warrant further investigation to optimize outcomes in rAAA management.