Timing and Location of Blood Product Transfusion and Outcomes in Massively Transfused Combat Casualties

Abstract

BACKGROUND: Hemostatic resuscitation using blood components in a 1:1:1 ratio of platelets:fresh frozen plasma:red blood cells (RBCs) is based on analyses of massive transfusion (MT, Q10 RBC units in 24 hours). These 24-hour analyses are weakened by survival bias and do not describe the timing and location of transfusions. Mortality outcomes associated with early (first 6 hours) resuscitation incorporating platelets, for combat casualties requiring MT, have not been reported. METHODS: We analyzed records for 8,618 casualties treated at the United States military hospital in Baghdad, Iraq, between January 2004 and December 2006. Patients (n 414) requiring MT, not receiving fresh whole blood, and surviving at least 1 hour (reducing survival bias) were divided into 6-hour apheresis platelet (aPLT) transfusion ratio groups: LOW (aPLT:RBC, e0.1, n 344) and HIGH (aPLT:RBC, 90.1, n 70). Baseline characteristics of groups were compared. Factors influencing survival on univariate analysis were included in Cox proportional hazards models of 24-hour and 30-day survival. RESULTS: Patients received aPLT in the emergency department (4%), operating room (45%), intensive care unit (51%). The HIGH group presented with higher (p G 0.05) admission International Normalized Ratio (1.6 vs. 1.4), base deficit (8 vs. 7), and temperature (36.7 vs. 36.4). Overall mortality was 27%. At 24 hours, the HIGH group showed lower mortality (10.0% vs. 22.1%, p 0.02). Absolute differences in 30-day mortality were not significant (HIGH, 18.6%; LOW, 28.8%, p 0.08). On adjusted analysis, the HIGH group was independently associated with increased survival: LOW group mortality hazard ratios were 4.1 at 24 hours and 2.3 at 30 days compared with HIGH group (p 0.03 for both). Increasing 6-hour FFP:RBC ratio was also independently associated with increased survival.

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Document Details

Document Type
Technical Report
Publication Date
Jan 01, 2012
Accession Number
ADA619372

Entities

People

  • Andrew P Cap
  • Jeremy G. Perkins
  • Lorne H Blackbourne
  • Matthew A. Borgman
  • Philip C Spinella

Organizations

  • United States Army Institute of Surgical Research

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Blood
  • Blood Transfusions
  • Cardiovascular Physiological Phenomena
  • Casualties
  • Combat Support Hospitals
  • Data Analysis
  • Databases
  • Embolism And Thrombosis
  • Health Services
  • Hospitals
  • Information Science
  • Medical Personnel
  • Military Medicine
  • Military Personnel
  • Statistical Analysis
  • Therapy
  • United States

Fields of Study

  • Medicine

Readers

  • Regression Analysis.
  • Trauma or Military Medicine