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A Leg Up: Evaluating Ultramassive Transfusion after Extremity Vascular Injury.

Zachary J Grady1, Melike N Harfouche2, Patrick Greiffenstein3

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Patients with extremity vascular injuries (EVI) requiring ultra-massive transfusion (UMT) have a higher survival rate than those without EVI. This study identified key factors associated with better outcomes in EVI patients receiving UMT.

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Area of Science:

  • Trauma Surgery
  • Vascular Surgery
  • Emergency Medicine

Background:

  • Extremity vascular injuries (EVI) are rare but life-threatening, sometimes necessitating ultra-massive transfusion (UMT) of ≥20 red cell units in 24 hours.
  • Understanding outcomes and survival predictors in EVI patients undergoing UMT is critical for improving patient management.

Purpose of the Study:

  • To evaluate the outcomes of patients with EVI who required UMT.
  • To identify variables associated with survival in this patient cohort.

Main Methods:

  • A retrospective, multicenter analysis of trauma patients who received UMT between 2016-2024.
  • Compared demographic, clinical, and outcome data between patients with and without EVI, with subgroup analysis based on mortality.

Main Results:

  • Of 1,155 UMT patients, 194 (16.8%) had EVI, predominantly penetrating injuries.
  • Patients with EVI had a higher survival rate (50.5%) compared to those without EVI (33.3%) (p<0.01).
  • In EVI patients, higher survival was associated with lower Injury Severity Score, higher initial heart rate and Glasgow Coma Scale score, higher platelet count, lower lactate, and smaller base deficit.

Conclusions:

  • Extremity vascular injuries are associated with improved survival in patients requiring ultra-massive transfusion.
  • Specific clinical parameters in EVI patients undergoing UMT can predict survival.