Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study

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

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

BACKGROUND: The classic definition ofmassive transfusion, 10 or more units of red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available, and may use, during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objectivewas to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding after injury. METHODS: Adult patients surviving at least 30minutes after admission and receiving one or more RBCswithin 6 hours of admission from10 US Level 1 trauma centers were enrolled in the PRospective ObservationalMulticenterMajor Trauma Transfusion (PROMMTT) study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L = 1 U), colloids (0.5 L = 1 U), and blood products (1 RBC = 1 U, 1 plasma = 1 U, 6 pack platelets = 1 U). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score (RTS), and Injury Severity Score (ISS). RESULTS: A total of 1,096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products used, the total fluidRIwas similar across all sites (3.2 ± 2.5U). Patientswho received four ormore units of any resuscitative fluid had a 6-hour mortality rate of 14.4%versus 4.5% in patients who received less than 4 U. The adjusted odds ratio of 6-hour mortality for patients receiving 4 U or more within 30 minutes was 2.1 (95% confidence interval, 1.2-3.5). CONCLUSION: Resuscitation with four ormore units of any fluid was significantly associated with 6-hourmortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness andmortality in severely bleeding patients.

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

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Resuscitation
Hemorrhage
Mortality
Wounds and Injuries
Erythrocytes
Injury Severity Score
Trauma Centers
Colloids
Blood Platelets
Logistic Models
Odds Ratio
Confidence Intervals
Survival

Keywords

  • Colloid
  • Crystalloid
  • Mortality
  • Plasma
  • Rate of transfusion

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Rahbar, E., Fox, E. E., Del Junco, D. J., Harvin, J. A., Holcomb, J. B., Wade, C. E., ... Cotton, B. A. (2013). Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study. Journal of Trauma and Acute Care Surgery, 75(1 SUPPL1). https://doi.org/10.1097/TA.0b013e31828fa535

Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study. / Rahbar, Elaheh; Fox, Erin E.; Del Junco, Deborah J.; Harvin, John A.; Holcomb, John B.; Wade, Charles E.; Schreiber, Martin A.; Rahbar, Mohammad H.; Bulger, Eileen M.; Phelan, Herb A.; Brasel, Karen J.; Alarcon, Louis H.; Myers, John G.; Cohen, Mitchell J.; Muskat, Peter; Cotton, Bryan A.

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

Research output: Contribution to journalArticle

Rahbar, E, Fox, EE, Del Junco, DJ, Harvin, JA, Holcomb, JB, Wade, CE, Schreiber, MA, Rahbar, MH, Bulger, EM, Phelan, HA, Brasel, KJ, Alarcon, LH, Myers, JG, Cohen, MJ, Muskat, P & Cotton, BA 2013, 'Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e31828fa535
Rahbar, Elaheh ; Fox, Erin E. ; Del Junco, Deborah J. ; Harvin, John A. ; Holcomb, John B. ; Wade, Charles E. ; Schreiber, Martin A. ; Rahbar, Mohammad H. ; Bulger, Eileen M. ; Phelan, Herb A. ; Brasel, Karen J. ; Alarcon, Louis H. ; Myers, John G. ; Cohen, Mitchell J. ; Muskat, Peter ; Cotton, Bryan A. / Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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abstract = "BACKGROUND: The classic definition ofmassive transfusion, 10 or more units of red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available, and may use, during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objectivewas to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding after injury. METHODS: Adult patients surviving at least 30minutes after admission and receiving one or more RBCswithin 6 hours of admission from10 US Level 1 trauma centers were enrolled in the PRospective ObservationalMulticenterMajor Trauma Transfusion (PROMMTT) study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L = 1 U), colloids (0.5 L = 1 U), and blood products (1 RBC = 1 U, 1 plasma = 1 U, 6 pack platelets = 1 U). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score (RTS), and Injury Severity Score (ISS). RESULTS: A total of 1,096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products used, the total fluidRIwas similar across all sites (3.2 ± 2.5U). Patientswho received four ormore units of any resuscitative fluid had a 6-hour mortality rate of 14.4{\%}versus 4.5{\%} in patients who received less than 4 U. The adjusted odds ratio of 6-hour mortality for patients receiving 4 U or more within 30 minutes was 2.1 (95{\%} confidence interval, 1.2-3.5). CONCLUSION: Resuscitation with four ormore units of any fluid was significantly associated with 6-hourmortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness andmortality in severely bleeding patients.",
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T1 - Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study

AU - Rahbar, Elaheh

AU - Fox, Erin E.

AU - Del Junco, Deborah J.

AU - Harvin, John A.

AU - Holcomb, John B.

AU - Wade, Charles E.

AU - Schreiber, Martin A.

AU - Rahbar, Mohammad H.

AU - Bulger, Eileen M.

AU - Phelan, Herb A.

AU - Brasel, Karen J.

AU - Alarcon, Louis H.

AU - Myers, John G.

AU - Cohen, Mitchell J.

AU - Muskat, Peter

AU - Cotton, Bryan A.

PY - 2013

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N2 - BACKGROUND: The classic definition ofmassive transfusion, 10 or more units of red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available, and may use, during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objectivewas to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding after injury. METHODS: Adult patients surviving at least 30minutes after admission and receiving one or more RBCswithin 6 hours of admission from10 US Level 1 trauma centers were enrolled in the PRospective ObservationalMulticenterMajor Trauma Transfusion (PROMMTT) study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L = 1 U), colloids (0.5 L = 1 U), and blood products (1 RBC = 1 U, 1 plasma = 1 U, 6 pack platelets = 1 U). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score (RTS), and Injury Severity Score (ISS). RESULTS: A total of 1,096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products used, the total fluidRIwas similar across all sites (3.2 ± 2.5U). Patientswho received four ormore units of any resuscitative fluid had a 6-hour mortality rate of 14.4%versus 4.5% in patients who received less than 4 U. The adjusted odds ratio of 6-hour mortality for patients receiving 4 U or more within 30 minutes was 2.1 (95% confidence interval, 1.2-3.5). CONCLUSION: Resuscitation with four ormore units of any fluid was significantly associated with 6-hourmortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness andmortality in severely bleeding patients.

AB - BACKGROUND: The classic definition ofmassive transfusion, 10 or more units of red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available, and may use, during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objectivewas to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding after injury. METHODS: Adult patients surviving at least 30minutes after admission and receiving one or more RBCswithin 6 hours of admission from10 US Level 1 trauma centers were enrolled in the PRospective ObservationalMulticenterMajor Trauma Transfusion (PROMMTT) study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L = 1 U), colloids (0.5 L = 1 U), and blood products (1 RBC = 1 U, 1 plasma = 1 U, 6 pack platelets = 1 U). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score (RTS), and Injury Severity Score (ISS). RESULTS: A total of 1,096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products used, the total fluidRIwas similar across all sites (3.2 ± 2.5U). Patientswho received four ormore units of any resuscitative fluid had a 6-hour mortality rate of 14.4%versus 4.5% in patients who received less than 4 U. The adjusted odds ratio of 6-hour mortality for patients receiving 4 U or more within 30 minutes was 2.1 (95% confidence interval, 1.2-3.5). CONCLUSION: Resuscitation with four ormore units of any fluid was significantly associated with 6-hourmortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness andmortality in severely bleeding patients.

KW - Colloid

KW - Crystalloid

KW - Mortality

KW - Plasma

KW - Rate of transfusion

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