Hypothermia in massive transfusion: Have we been paying enough attention to it?

Benjamin R. Reynolds, Raquel M. Forsythe, Brian G. Harbrecht, Joseph Cuschieri, Joseph P. Minei, Ronald V. Maier, Ernest E. Moore, Timothy R. Billiar, Andrew B. Peitzman, Jason L. Sperry

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

OBJECTIVE: The development of acidosis, coagulopathy, and hypothermia has been shown to adversely affect survival after injury. Significant attention has focused on the correction of the early coagulopathy in those requiring massive transfusion (MT). We sought to characterize the importance of temperature as a risk factor for poor outcome relative to the changes in MT resuscitation that have occurred. METHODS: Data were obtained from a multicenter prospective cohort study of adults with blunt injury with hemorrhagic shock. MTwas defined as 10 U or more of packed red blood cell (PRBC) during 24 hours. The lowest 24-hour temperature was categorized into groups (<34.0°C, 34.1-35.0°C, 35.1-36.0°C, and >36°C). A Kaplan-Meier analysis and a multivariate logistic regression were used to analyze temperature survival differences over time and independent risks of mortality after controlling for all important confounders. RESULTS: In the MT cohort (n = 604), as temperature decreased, shock parameters, early coagulopathy, injury severity, and blood component transfusion requirements significantly increased. A Kaplan-Meier comparison revealed a dose-response relationship with a temperature lower than 34-C resulting in the greatest mortality. Logistic regression analysis demonstrated that a temperature lower than 34-C was associated with a greater independent risk of mortality of more than 80% after controlling for differences in shock, coagulopathy, injury severity, and transfusion requirements (odds ratio, 1.87; 95% confidence interval, 1.18-3.0; p = 0.007). When the cohort was stratified into high or low plasma to red blood cell transfusion ratio groups (high fresh frozen plasma [FFP]/PRBC, ≥1:2 vs. low FFP/PRBC, <1:2), regression modeling demonstrated that a temperature lower than 34°C was associated with a twofold higher independent risk of mortality, only in the low FFP/PRBC transfusion group. CONCLUSION: A temperature of 34°C seems to define a clinically significant hypothermia in MT. The independent risks of mortality were greatest in those who received a low FFP/PRBC transfusion ratio. These data suggest that the prevention of hypothermia may be as important as addressing early coagulopathy. Further research is required to verify if the prevention or correction of hypothermia improves the outcome of patients requiring MT.

Original languageEnglish (US)
Pages (from-to)486-491
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number2
DOIs
StatePublished - Aug 2012

Fingerprint

Hypothermia
Temperature
Erythrocyte Transfusion
Mortality
Erythrocytes
Shock
Wounds and Injuries
Blood Component Transfusion
Logistic Models
Nonpenetrating Wounds
Hemorrhagic Shock
Kaplan-Meier Estimate
Survival Analysis
Acidosis
Resuscitation
Cohort Studies
Odds Ratio
Regression Analysis
Prospective Studies
Confidence Intervals

Keywords

  • celsius
  • logistic regression
  • multiple organ failure
  • Temperature

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Reynolds, B. R., Forsythe, R. M., Harbrecht, B. G., Cuschieri, J., Minei, J. P., Maier, R. V., ... Sperry, J. L. (2012). Hypothermia in massive transfusion: Have we been paying enough attention to it? Journal of Trauma and Acute Care Surgery, 73(2), 486-491. https://doi.org/10.1097/TA.0b013e31825c163b

Hypothermia in massive transfusion : Have we been paying enough attention to it? / Reynolds, Benjamin R.; Forsythe, Raquel M.; Harbrecht, Brian G.; Cuschieri, Joseph; Minei, Joseph P.; Maier, Ronald V.; Moore, Ernest E.; Billiar, Timothy R.; Peitzman, Andrew B.; Sperry, Jason L.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 2, 08.2012, p. 486-491.

Research output: Contribution to journalArticle

Reynolds, BR, Forsythe, RM, Harbrecht, BG, Cuschieri, J, Minei, JP, Maier, RV, Moore, EE, Billiar, TR, Peitzman, AB & Sperry, JL 2012, 'Hypothermia in massive transfusion: Have we been paying enough attention to it?', Journal of Trauma and Acute Care Surgery, vol. 73, no. 2, pp. 486-491. https://doi.org/10.1097/TA.0b013e31825c163b
Reynolds, Benjamin R. ; Forsythe, Raquel M. ; Harbrecht, Brian G. ; Cuschieri, Joseph ; Minei, Joseph P. ; Maier, Ronald V. ; Moore, Ernest E. ; Billiar, Timothy R. ; Peitzman, Andrew B. ; Sperry, Jason L. / Hypothermia in massive transfusion : Have we been paying enough attention to it?. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 2. pp. 486-491.
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AU - Cuschieri, Joseph

AU - Minei, Joseph P.

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N2 - OBJECTIVE: The development of acidosis, coagulopathy, and hypothermia has been shown to adversely affect survival after injury. Significant attention has focused on the correction of the early coagulopathy in those requiring massive transfusion (MT). We sought to characterize the importance of temperature as a risk factor for poor outcome relative to the changes in MT resuscitation that have occurred. METHODS: Data were obtained from a multicenter prospective cohort study of adults with blunt injury with hemorrhagic shock. MTwas defined as 10 U or more of packed red blood cell (PRBC) during 24 hours. The lowest 24-hour temperature was categorized into groups (<34.0°C, 34.1-35.0°C, 35.1-36.0°C, and >36°C). A Kaplan-Meier analysis and a multivariate logistic regression were used to analyze temperature survival differences over time and independent risks of mortality after controlling for all important confounders. RESULTS: In the MT cohort (n = 604), as temperature decreased, shock parameters, early coagulopathy, injury severity, and blood component transfusion requirements significantly increased. A Kaplan-Meier comparison revealed a dose-response relationship with a temperature lower than 34-C resulting in the greatest mortality. Logistic regression analysis demonstrated that a temperature lower than 34-C was associated with a greater independent risk of mortality of more than 80% after controlling for differences in shock, coagulopathy, injury severity, and transfusion requirements (odds ratio, 1.87; 95% confidence interval, 1.18-3.0; p = 0.007). When the cohort was stratified into high or low plasma to red blood cell transfusion ratio groups (high fresh frozen plasma [FFP]/PRBC, ≥1:2 vs. low FFP/PRBC, <1:2), regression modeling demonstrated that a temperature lower than 34°C was associated with a twofold higher independent risk of mortality, only in the low FFP/PRBC transfusion group. CONCLUSION: A temperature of 34°C seems to define a clinically significant hypothermia in MT. The independent risks of mortality were greatest in those who received a low FFP/PRBC transfusion ratio. These data suggest that the prevention of hypothermia may be as important as addressing early coagulopathy. Further research is required to verify if the prevention or correction of hypothermia improves the outcome of patients requiring MT.

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