Determinants of mortality after massive transfusion - A prospective study

Area of Science:

• Trauma and Emergency Medicine
• Transfusion Medicine
• Critical Care

Background:

• Massive hemorrhage necessitates massive transfusions (MTs) for hemostasis.
• Massive transfusion protocols (MTPs) standardize blood component delivery, optimizing patient care.
• Conventional crystalloid use is replaced by MTPs in managing severe bleeding.

Purpose of the Study:

• To determine the ideal blood component ratio for MTPs.
• To assess the relationship between transfused component ratios and patient mortality.

Main Methods:

• Defined MT as >4 packed red blood cell (PRBC) units within 1 hour.
• Included 61 patients aged >13 years undergoing MT from December 2015 to October 2017.
• Analyzed physician-driven ratios of fresh frozen plasma (FFP):PRBC and platelet:PRBC against mortality outcomes.

Main Results:

• Overall hospital mortality was 8.1%, with 100% mortality in penetrating trauma cases.
• Emergency admission and pre-MT hypotension were independent risk factors for mortality.
• Survivors predominantly received equal ratios (1:1:1) of PRBC:FFP:platelet, while non-survivors received low FFP:PRBC ratios.

Conclusions:

• A 1:1:1 ratio of PRBC:FFP:platelet is associated with improved survival in MT.
• Establishing institutional MTPs and ensuring compliance are critical.
• Further prospective randomized controlled trials are needed to validate a universal protocol.