The Need for Aggressive Correction of Hypocalcemia During Traumatic Massive Transfusion Protocol

Area of Science:

• Trauma critical care
• Transfusion medicine
• Critical care nephrology

Background:

• Hypocalcemia is a frequent complication following massive transfusion protocols (MTP) in trauma patients.
• The direct physiological impact of hypocalcemia severity on mortality risk in MTP patients requires further investigation.
• Understanding calcium level dynamics is crucial for managing MTP-associated complications.

Purpose of the Study:

• To investigate the association between calcium levels and mortality in trauma patients undergoing MTP.
• To test the hypothesis that hypocalcemia increases the risk of mortality in MTP patients.
• To evaluate the impact of calcium administration timing and levels on patient outcomes.

Main Methods:

• Retrospective review of 153 trauma patients who received MTP (≥10 units of blood within 24 hours) between 2018 and 2023.
• Ionized calcium (iCal) levels measured on admission and post-MTP; calcium administered with every four red blood cell units.
• Logistic regression analysis used to identify risk factors for 6- and 24-hour mortality.

Main Results:

• Overall 6-hour mortality was 26% and 24-hour mortality was 34%.
• Patients who died within 6 hours had significantly lower post-MTP iCal levels (0.84 vs 1.27 mmol/L) and received more calcium (6g vs 4g).
• Higher post-MTP iCal was strongly associated with decreased odds of mortality (OR 0.013), remaining significant in multivariable analysis.

Conclusions:

• Hypocalcemia following MTP in trauma patients is significantly associated with increased short-term mortality.
• Aggressive and early correction of hypocalcemia may be a critical intervention to reduce mortality in MTP patients.
• Monitoring and management of ionized calcium levels are essential components of MTP care.