Ultramassive Transfusion for Trauma in the Age of Hemostatic Resuscitation: A Retrospective Single-Center Cohort From a Large US Level-1 Trauma Center, 2011–2021
Authors' conclusion
One in 420 acute trauma patients at our center received UMT, a historically low rate. A third of these patients lived, and UMT was not itself a marker of futility. Early identification of coagulopathy was possible, and failure to give blood components in hemostatic ratios was associated with excess mortality.
Study context
- Population
- Trauma patients receiving ultramassive transfusion (≥20 units RBCs/24 hours) in the first 24 hours of care, US level-1 trauma center, 2011–2021of 66,734 trauma admissions
- Participants
- 159 patients
- Outcome
- Mortality (discharge status) and its associated factors
Methodological detailssingle-centre, US level-1 adult and pediatric trauma center
- Single-centre
- US level-1 adult and pediatric trauma center
Main finding
As reported in the abstract
Overall mortality
- Overall mortality
- 65% (n = 103)
- Ultramassive transfusion (UMT) rate among trauma admissions
- 0.23%
- UMT in hemostatic proportions
- 81%
- Mean ISS
- 40
- Median time to death
- 6.1 hours
Observational data: associations, not effects.
Further findings
Univariate associations with death
- Death not associated with age, sex, or more RBC units transfused beyond 20
- Death associated with blunt injury, increasing injury severity, severe head injury, failure to receive hemostatic ratios, decreased pH and admission coagulopathy, especially hypofibrinogenemia
Original publication
Ultramassive Transfusion for Trauma in the Age of Hemostatic Resuscitation: A Retrospective Single-Center Cohort From a Large US Level-1 Trauma Center, 2011–2021. Anesth Analg. Published 14 April 2023. doi:10.
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