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Updated: May 14, 2025
Integrated Compensatory Responses in a Human Model of Hemorrhage
Published on: November 20, 2016
Filling the tank: A multicenter investigation of trauma survival after ultramassive transfusion
Zachary J Grady1, Jonathan Nguyen, Courtney H Meyer
1From the Department of Surgery (Z.J.G., C.H.M., J.S., R.N.S.), Emory University School of Medicine, Atlanta, Georgia; Department of Surgery (J.N.), Morehouse School of Medicine, Atlanta, Georgia; Department of Emergency Medicine (T.P.M., M.R.), Emory University School of Medicine, Atlanta, Georgia; Department of Surgery (A.Z., M.N.H.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery (P.G., S.T.), LSU School of Medicine, New Orleans, Louisiana; Department of Surgery (K.I., N.N.), Keck Medicine of USC, Los Angeles, California; Department of Surgery (D.M.F., C.E.J.S.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (A.G., J.P.M.), Ryder Trauma/University of Miami, Miami, Florida; The Hiram C. Polk, Jr., Department of Surgery (W.B.R., J.W.S.), University of Louisville, Louisville, Kentucky; Department of Surgery (C.L.J.), Temple University Hospital, Philadelphia, Pennsylvania; Lewis Katz School of Medicine (E.D.T.), Temple University, Philadelphia, Pennsylvania; Department of Surgery (A.G.M.), Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada; Department of Surgery (A.K., R.L.C.), Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; and Department of Surgery (S.W.R., V.C.S.), Carolinas Medical Center, Charlotte, North Carolina.
Introduction:
Ultramassive transfusion (UMT), transfusion of ≥20U of red blood cell products in the first 24 hours, is rare, requires significant resource utilization, and is associated with high mortality. The aim of this study was to describe the characteristics of trauma patients undergoing UMT and determine patterns associated with survival after UMT.
Methods:
This retrospective, multicenter analysis from 11 high-volume trauma centers included traumatically injured patients older than 14 years who received UMT from 2016 to 2024. Demographic, clinical, and outcome data were obtained and compared between survivors and nonsurvivors. The primary outcome was survival with secondary outcome of need for specific operative interventions.
Results:
A total of 1,155 patients received UMT with a mortality rate of 62.9%. Between survivors and nonsurvivors, there was no difference in mechanism of injury. Survivors presented were tachycardic (120 vs. 98 beats per minute, p < 0.001) and had a higher initial Glasgow Coma Scale score (14 vs. 3, p < 0.001), higher initial platelet count (189 vs. 149 10 3 /μL, p < 0.001), and smaller initial base deficit (8 vs. 11.8 mmol/L, p < 0.001). Survivors underwent more extremity explorations (25.2% vs. 14.4%, p < 0.001) and had more extremity vascular injuries (22.9% vs. 13.2%, p < 0.001). The odds of mortality increased with age (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.015-1.037; p < 0.001), Injury Severity Score (OR, 1.025; 95% CI, 1.013-1.036; p < 0.001), initial lactate (OR, 1.119; 95% CI, 1.079-1.161; p < 0.001), and emergency department thoracotomy (OR, 3.92; 95% CI, 2.129-7.223; p < 0.001). The odds of mortality decreased with higher Glasgow Coma Scale score (OR, 0.93; 95% CI, 0.897-0.962; p < 0.001), heart rate (OR, 0.995; 95% CI, 0.990-0.9997; p = 0.04), and initial platelet count (OR, 0.998; 95% CI, 0.996-0.999; p = 0.04).
Conclusion:
This study affirms known factors influencing mortality in UMT and describes new patterns associated with reduced mortality including higher initial heart rate, extremity exploration, and concomitant extremity vascular injury. These findings can inform clinical decision making in the care of this challenging patient population.
Level Of Evidence:
Therapeutic/Care Management; Level III.
