A Retrospective Study of Ultramassive Transfusion in Trauma Patients: Is There a Value After Which Additional Transfusions Are Futile?
Authors' conclusion
In this study, patients who received UMT had higher mortality and worse outcomes than those who received fewer units. However, this study did not identify a threshold beyond which all patients died
Study context
- Population
- Adult trauma patients (≥18 years) who underwent surgery and received blood products within 24 hours of admission at 7 US Level I trauma centers, 2016–2022
- Participants
- 3,248 patients · 7 trauma centers
- Exposure
- Ultramassive transfusion (UMT) vs <20 RBC units
- UMTn = 333
- <20 RBC unitsn = 2,913reference
- Outcome
- Outcomes associated with UMT, incl. mortality, and a threshold beyond which additional transfusion is futile
Methodological detailsmulticentre, segmented logistic regression
- Multicentre
- Segmented logistic regression
Main finding
As reported in the abstract
Mortality
UMT vs <20 RBC unitsRelative risk (95% CI)P value
24-hour mortality
6.00(4.79–7.52)
P < 0.001Index hospitalization mortality
3.99(3.34–4.75)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | RR (CI) | P value | |
|---|---|---|---|
| Risk of death by RBC units received (vs 20 to 29 units)30 to 44 RBC units vs 20 to 29 RBC units · statistically similar | 1.32 (0.93–1.87) | P = 0.12 | |
| Risk of death by RBC units received (vs 20 to 29 units)≥45 RBC units vs 20 to 29 RBC units | 1.59 (1.12–2.25) | P = 0.009 | |
| 0.512Relative risk (log scale) |
Risk of death by RBC units received (vs 20 to 29 units)
- Additional transfusion beyond ≥45 RBC units did not improve the probability of survival
Safety
| Outcome | RR (CI) | P value | |
|---|---|---|---|
| Complications | 1.67 (1.44–1.94) | P < 0.001 | |
| Multiple organ failure | 2.78 (2.20–3.52) | P < 0.001 | |
| 0.20.5125Relative risk (log scale) |
Original publication
A Retrospective Study of Ultramassive Transfusion in Trauma Patients: Is There a Value After Which Additional Transfusions Are Futile? Anesth Analg. Published 20 October 2025. doi:10.
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