Cryoprecipitate use in the PROMMTT study

John B. Holcomb, Erin E. Fox, Xuan Zhang, Nathan White, Charles E. Wade, Bryan A. Cotton, Deborah J. Del Junco, Eileen M. Bulger, Mitchell J. Cohen, Martin A. Schreiber, John G. Myers, Karen J. Brasel, Herb A. Phelan, Louis H. Alarcon, Peter Muskat, Mohammad H. Rahbar

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1 SUPPL1
DOIs
StatePublished - 2013

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Fibrinogen
Injury Severity Score
Wounds and Injuries
Hospital Mortality
Hospital Emergency Service
Hemoglobins
Blood Pressure
Glasgow Coma Scale
International Normalized Ratio
Survival
Partial Thromboplastin Time
Trauma Centers
Prothrombin Time
Proportional Hazards Models
Abdomen
Thorax
Logistic Models

Keywords

  • Bleeding
  • Cryoprecipitate
  • Fibrinogen
  • Injury
  • PROMMTT

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Holcomb, J. B., Fox, E. E., Zhang, X., White, N., Wade, C. E., Cotton, B. A., ... Rahbar, M. H. (2013). Cryoprecipitate use in the PROMMTT study. Journal of Trauma and Acute Care Surgery, 75(1 SUPPL1). https://doi.org/10.1097/TA.0b013e31828fa3ed

Cryoprecipitate use in the PROMMTT study. / Holcomb, John B.; Fox, Erin E.; Zhang, Xuan; White, Nathan; Wade, Charles E.; Cotton, Bryan A.; Del Junco, Deborah J.; Bulger, Eileen M.; Cohen, Mitchell J.; Schreiber, Martin A.; Myers, John G.; Brasel, Karen J.; Phelan, Herb A.; Alarcon, Louis H.; Muskat, Peter; Rahbar, Mohammad H.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1 SUPPL1, 2013.

Research output: Contribution to journalArticle

Holcomb, JB, Fox, EE, Zhang, X, White, N, Wade, CE, Cotton, BA, Del Junco, DJ, Bulger, EM, Cohen, MJ, Schreiber, MA, Myers, JG, Brasel, KJ, Phelan, HA, Alarcon, LH, Muskat, P & Rahbar, MH 2013, 'Cryoprecipitate use in the PROMMTT study', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e31828fa3ed
Holcomb JB, Fox EE, Zhang X, White N, Wade CE, Cotton BA et al. Cryoprecipitate use in the PROMMTT study. Journal of Trauma and Acute Care Surgery. 2013;75(1 SUPPL1). https://doi.org/10.1097/TA.0b013e31828fa3ed
Holcomb, John B. ; Fox, Erin E. ; Zhang, Xuan ; White, Nathan ; Wade, Charles E. ; Cotton, Bryan A. ; Del Junco, Deborah J. ; Bulger, Eileen M. ; Cohen, Mitchell J. ; Schreiber, Martin A. ; Myers, John G. ; Brasel, Karen J. ; Phelan, Herb A. ; Alarcon, Louis H. ; Muskat, Peter ; Rahbar, Mohammad H. / Cryoprecipitate use in the PROMMTT study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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AU - Holcomb, John B.

AU - Fox, Erin E.

AU - Zhang, Xuan

AU - White, Nathan

AU - Wade, Charles E.

AU - Cotton, Bryan A.

AU - Del Junco, Deborah J.

AU - Bulger, Eileen M.

AU - Cohen, Mitchell J.

AU - Schreiber, Martin A.

AU - Myers, John G.

AU - Brasel, Karen J.

AU - Phelan, Herb A.

AU - Alarcon, Louis H.

AU - Muskat, Peter

AU - Rahbar, Mohammad H.

PY - 2013

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N2 - BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

AB - BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

KW - Bleeding

KW - Cryoprecipitate

KW - Fibrinogen

KW - Injury

KW - PROMMTT

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