Supermassive Transfusion: A 15-Year Single Center Experience and Outcomes

Area of Science:

• Trauma Surgery
• Transfusion Medicine
• Critical Care Medicine

Background:

• Massive blood transfusions are critical interventions for severe trauma patients.
• Understanding the survival outcomes associated with large-volume transfusions is essential for optimizing patient care.

Purpose of the Study:

• To determine the survival outcomes in trauma patients receiving large-volume packed red blood cell (pRBC) transfusions.
• To identify risk factors for mortality in this patient cohort.

Main Methods:

• Retrospective study of trauma patients receiving ≥25 units of pRBC within 24 hours.
• Univariate and multivariable logistic regression analyses were used to identify mortality risk factors.
• Receiver operating characteristic curve analysis assessed the predictive ability of pRBC volume for mortality.

Main Results:

• Out of 74,065 adults, 178 (0.24%) received ≥25 units pRBC. Overall mortality was 65.2%.
• Mortality rates were similar across transfusion volumes of 25-49 units (64.1%) and 50-74 units (64.3%).
• Patients receiving ≥75 units had a significantly higher mortality rate (87.5%). Female gender, lower Glasgow Coma Scale, higher Injury Severity Score, and thoracotomy were associated with increased mortality.

Conclusions:

• No specific packed red blood cell transfusion volume cutoff was significantly associated with higher mortality in trauma patients.
• Extremely large transfusion volumes (≥75 units) were linked to a higher mortality rate.
• Factors such as injury severity and neurological status remain critical predictors of survival in massively transfused trauma patients.