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Cresting mortality: Defining a plateau in ongoing massive transfusion.

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Massive transfusion in trauma patients has mortality thresholds. Beyond a total transfusion volume of approximately 40 units, further blood products do not significantly impact survival rates.

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Area of Science:

  • Trauma surgery
  • Critical care medicine
  • Hematology

Background:

  • Blood-based balanced resuscitation is standard for massive hemorrhage in trauma.
  • Optimal transfusion volume thresholds impacting mortality are not well-defined.

Purpose of the Study:

  • To identify a threshold for total transfusion volume (TTV) beyond which in-hospital mortality is no longer significantly affected in massively bleeding trauma patients.

Main Methods:

  • Analysis of the Trauma Quality Improvement database (2013-2017) for adult trauma patients receiving blood products within 4 hours of arrival.
  • Evaluation of in-hospital mortality based on TTV at 4 and 24 hours in overall and balanced transfusion cohorts.
  • Application of bootstrapping and multivariable Poisson regression to determine mortality plateau thresholds.

Main Results:

  • Mortality plateaued after a TTV of approximately 40.5 units at 4 hours and 52.8 units at 24 hours in the overall cohort.
  • In the balanced transfusion cohort, mortality plateaued at 39 units at 4 hours and 53 units at 24 hours.

Conclusions:

  • Specific total transfusion volume thresholds exist beyond which further resuscitation does not significantly alter mortality.
  • These identified TTVs can serve as markers for "resuscitation timeouts" to re-evaluate patient care strategies.