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

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.