Early blood product and crystalloid volume resuscitation: Risk association with multiple organ dysfunction after severe blunt traumatic injury

Scott C. Brakenridge, Herb A. Phelan, Steven S. Henley, Richard M. Golden, T. Michael Kashner, Alexander E. Eastman, Jason L. Sperry, Brian G. Harbrecht, Ernest E. Moore, Joseph Cuschieri, Ronald V. Maier, Joseph P. Minei

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Elements of volume resuscitation from hemorrhagic shock, such as amount of blood product and crystalloid administration, have been shown to be associated with multiple organ dysfunction (MOD). However, it is unknown whether these are causative factors or merely markers of an underlying requirement for large-volume resuscitation. We sought to further delineate the relevance of the major individual components of early volume resuscitation to onset of MOD after severe blunt traumatic injury. Methods: We performed a secondary analysis of a large, multicenter prospective observational cohort of severely injured blunt trauma patients, the NIGMS Trauma Glue Grant, to assess the relevance of individual components of resuscitation administered in the first 12 hours of resuscitation including packed red blood cells (PRBC), fresh frozen plasma (FFP), and isotonic crystalloid, to the onset of MOD within the first 28 days after injury. Deaths within 48 hours of injury were excluded. We used a two tiered, exhaustive logistic regression model search technique to adjust for potential confounders from clinically relevant MOD covariates, including indicators of shock severity, injury severity, comorbidities, age, and gender. Results: The study cohort consisted of 1,366 severely injured blunt trauma patients (median new Injury Severity Score = 34). Incidence of 28-day Marshall MOD was 19.6%. Transfusion of ≥10 Units of PRBC in the first 12 hours (odds ratio, 2.06; 95% confidence interval 1.44-2.94), but not FFP (≥8 U) or large volume crystalloid administration (≥12 L), was independently associated with onset of 28-day Marshall MOD. PRBC:FFP ratio in the first 12 hours was not significantly associated with MOD. Conclusions: When controlling for all major components of acute volume resuscitation, massive-transfusion volumes of PRBC's within the first 12 hours of resuscitation are modestly associated with MOD, whereas FFP and large volume crystalloid administration are not independently associated with MOD. Previous reported associations of blood products and large-volume crystalloid with MOD may be reflecting overall resuscitation requirements and burden of injury rather than independent causation.

Original languageEnglish (US)
Pages (from-to)299-305
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number2
DOIs
StatePublished - Aug 2011

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Nonpenetrating Wounds
Resuscitation
Wounds and Injuries
Erythrocytes
National Institute of General Medical Sciences (U.S.)
Logistic Models
Injury Severity Score
Hemorrhagic Shock
crystalloid solutions
Plasma Volume
Causality
Adhesives
Comorbidity
Shock
Cohort Studies
Odds Ratio
Confidence Intervals
Incidence

Keywords

  • Blood
  • Injury
  • Multiple organ dysfunction
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Early blood product and crystalloid volume resuscitation : Risk association with multiple organ dysfunction after severe blunt traumatic injury. / Brakenridge, Scott C.; Phelan, Herb A.; Henley, Steven S.; Golden, Richard M.; Kashner, T. Michael; Eastman, Alexander E.; Sperry, Jason L.; Harbrecht, Brian G.; Moore, Ernest E.; Cuschieri, Joseph; Maier, Ronald V.; Minei, Joseph P.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 2, 08.2011, p. 299-305.

Research output: Contribution to journalArticle

Brakenridge, SC, Phelan, HA, Henley, SS, Golden, RM, Kashner, TM, Eastman, AE, Sperry, JL, Harbrecht, BG, Moore, EE, Cuschieri, J, Maier, RV & Minei, JP 2011, 'Early blood product and crystalloid volume resuscitation: Risk association with multiple organ dysfunction after severe blunt traumatic injury', Journal of Trauma - Injury, Infection and Critical Care, vol. 71, no. 2, pp. 299-305. https://doi.org/10.1097/TA.0b013e318224d328
Brakenridge, Scott C. ; Phelan, Herb A. ; Henley, Steven S. ; Golden, Richard M. ; Kashner, T. Michael ; Eastman, Alexander E. ; Sperry, Jason L. ; Harbrecht, Brian G. ; Moore, Ernest E. ; Cuschieri, Joseph ; Maier, Ronald V. ; Minei, Joseph P. / Early blood product and crystalloid volume resuscitation : Risk association with multiple organ dysfunction after severe blunt traumatic injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. 2. pp. 299-305.
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abstract = "Background: Elements of volume resuscitation from hemorrhagic shock, such as amount of blood product and crystalloid administration, have been shown to be associated with multiple organ dysfunction (MOD). However, it is unknown whether these are causative factors or merely markers of an underlying requirement for large-volume resuscitation. We sought to further delineate the relevance of the major individual components of early volume resuscitation to onset of MOD after severe blunt traumatic injury. Methods: We performed a secondary analysis of a large, multicenter prospective observational cohort of severely injured blunt trauma patients, the NIGMS Trauma Glue Grant, to assess the relevance of individual components of resuscitation administered in the first 12 hours of resuscitation including packed red blood cells (PRBC), fresh frozen plasma (FFP), and isotonic crystalloid, to the onset of MOD within the first 28 days after injury. Deaths within 48 hours of injury were excluded. We used a two tiered, exhaustive logistic regression model search technique to adjust for potential confounders from clinically relevant MOD covariates, including indicators of shock severity, injury severity, comorbidities, age, and gender. Results: The study cohort consisted of 1,366 severely injured blunt trauma patients (median new Injury Severity Score = 34). Incidence of 28-day Marshall MOD was 19.6{\%}. Transfusion of ≥10 Units of PRBC in the first 12 hours (odds ratio, 2.06; 95{\%} confidence interval 1.44-2.94), but not FFP (≥8 U) or large volume crystalloid administration (≥12 L), was independently associated with onset of 28-day Marshall MOD. PRBC:FFP ratio in the first 12 hours was not significantly associated with MOD. Conclusions: When controlling for all major components of acute volume resuscitation, massive-transfusion volumes of PRBC's within the first 12 hours of resuscitation are modestly associated with MOD, whereas FFP and large volume crystalloid administration are not independently associated with MOD. Previous reported associations of blood products and large-volume crystalloid with MOD may be reflecting overall resuscitation requirements and burden of injury rather than independent causation.",
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AU - Phelan, Herb A.

AU - Henley, Steven S.

AU - Golden, Richard M.

AU - Kashner, T. Michael

AU - Eastman, Alexander E.

AU - Sperry, Jason L.

AU - Harbrecht, Brian G.

AU - Moore, Ernest E.

AU - Cuschieri, Joseph

AU - Maier, Ronald V.

AU - Minei, Joseph P.

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N2 - Background: Elements of volume resuscitation from hemorrhagic shock, such as amount of blood product and crystalloid administration, have been shown to be associated with multiple organ dysfunction (MOD). However, it is unknown whether these are causative factors or merely markers of an underlying requirement for large-volume resuscitation. We sought to further delineate the relevance of the major individual components of early volume resuscitation to onset of MOD after severe blunt traumatic injury. Methods: We performed a secondary analysis of a large, multicenter prospective observational cohort of severely injured blunt trauma patients, the NIGMS Trauma Glue Grant, to assess the relevance of individual components of resuscitation administered in the first 12 hours of resuscitation including packed red blood cells (PRBC), fresh frozen plasma (FFP), and isotonic crystalloid, to the onset of MOD within the first 28 days after injury. Deaths within 48 hours of injury were excluded. We used a two tiered, exhaustive logistic regression model search technique to adjust for potential confounders from clinically relevant MOD covariates, including indicators of shock severity, injury severity, comorbidities, age, and gender. Results: The study cohort consisted of 1,366 severely injured blunt trauma patients (median new Injury Severity Score = 34). Incidence of 28-day Marshall MOD was 19.6%. Transfusion of ≥10 Units of PRBC in the first 12 hours (odds ratio, 2.06; 95% confidence interval 1.44-2.94), but not FFP (≥8 U) or large volume crystalloid administration (≥12 L), was independently associated with onset of 28-day Marshall MOD. PRBC:FFP ratio in the first 12 hours was not significantly associated with MOD. Conclusions: When controlling for all major components of acute volume resuscitation, massive-transfusion volumes of PRBC's within the first 12 hours of resuscitation are modestly associated with MOD, whereas FFP and large volume crystalloid administration are not independently associated with MOD. Previous reported associations of blood products and large-volume crystalloid with MOD may be reflecting overall resuscitation requirements and burden of injury rather than independent causation.

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