Defining Ultra-Massive Transfusion through a Systematic Review

Area of Science:

• Trauma care
• Hemorrhagic shock management
• Blood product transfusion protocols

Background:

• Ultra-massive transfusion (UMT) is critical for trauma patients experiencing hemorrhagic shock.
• A standardized definition for UMT is currently lacking, hindering consistent clinical application and research.
• This systematic review aimed to establish a consensus definition for UMT.

Approach:

• A systematic literature review was conducted from 1979 to 2022.
• Studies defining UMT and associated outcomes were screened using PICO questions.
• PRISMA guidelines were followed for study selection and data extraction.

Key Points:

• Only two studies provided a consensus definition for UMT: ≥20 units of red blood cell product within 24 hours.
• Factors linked to increased mortality in UMT patients include lower blood pressure, pulse, and Glasgow Coma Score upon presentation.
• Higher injury severity scores and undergoing resuscitative thoracotomy were also associated with poorer outcomes.

Conclusions:

• The lack of a standardized UMT definition presents clinical, research, and ethical challenges.
• Standardizing UMT definition to ≥20 red blood cell units/24 hours is feasible and recommended.
• This standardization will improve consistency in trauma care and research involving massive transfusion protocols.