Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications

Bryan A. Cotton, Brigham K. Au, Timothy C. Nunez, Oliver L. Gunter, Amy M. Robertson, Pampee P. Young

Research output: Contribution to journalArticle

232 Citations (Scopus)

Abstract

Massive transfusion (MT) protocols have been shown to improve survival in severely injured patients. However, others have noted that these higher fresh frozen plasma (FFP): red blood cell (RBC) ratios are associated with increased risk of organ failure. The purpose of this study was to determine whether MT protocols are associated with increased organ failure and complications. Methods: Our institution's exsanguination protocol (TEP) involves the immediate delivery of products in a 3:2 ratio of RBC:FFP and 5:1 for RBC:platelets. All patients receiving TEP between February 2006 and January 2008 were compared with a cohort (pre-TEP) of all patients from February 2004 to January 2006 that (1) went immediately to the operating room and (2) received MT (≥10 units of RBC in first 24 hours). Results: Two hundred sixty-four patients met inclusion (125 in the TEP group, 141 in the pre-TEP). Demographics and Injury Severity Score were similar. TEP received more intraoperative FFP and platelets but less in first 24 hours (p < 0.01). There was no difference in renal failure or systemic inflammatory response syndrome, but pneumonia, pulmonary failure, open abdomens, and abdominal compartment syndrome were lower in TEP. In addition, severe sepsis or septic shock and multiorgan failure were both lower in the TEP patients (9% vs. 20%, p = 0.011 and 16% vs. 37%, p < 0.001, respectively). Conclusions: Although MT has been associated with higher organ failure and complication rates, this risk appears to be reduced when blood products are delivered early in the resuscitation through a predefined protocol. Our institution's TEP was associated with a reduction in multiorgan failure and infectious complications, as well as an increase in ventilatorfree days. In addition, implementation ofthis protocol was followed by a dramatic reduction in development of abdominal compartment syndrome and the incidence of open abdomens.

Original languageEnglish (US)
Pages (from-to)41-48
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue number1
DOIs
StatePublished - Jan 1 2009

Fingerprint

Erythrocytes
Intra-Abdominal Hypertension
Abdomen
Blood Platelets
Exsanguination
tetraethylpyrazine
Systemic Inflammatory Response Syndrome
Injury Severity Score
Operating Rooms
Septic Shock
Resuscitation
Renal Insufficiency
Sepsis
Pneumonia
Demography
Lung
Survival
Incidence

Keywords

  • Exsanguination
  • Hemorrhage
  • Massive transfusion
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. / Cotton, Bryan A.; Au, Brigham K.; Nunez, Timothy C.; Gunter, Oliver L.; Robertson, Amy M.; Young, Pampee P.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 66, No. 1, 01.01.2009, p. 41-48.

Research output: Contribution to journalArticle

Cotton, Bryan A. ; Au, Brigham K. ; Nunez, Timothy C. ; Gunter, Oliver L. ; Robertson, Amy M. ; Young, Pampee P. / Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 66, No. 1. pp. 41-48.
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abstract = "Massive transfusion (MT) protocols have been shown to improve survival in severely injured patients. However, others have noted that these higher fresh frozen plasma (FFP): red blood cell (RBC) ratios are associated with increased risk of organ failure. The purpose of this study was to determine whether MT protocols are associated with increased organ failure and complications. Methods: Our institution's exsanguination protocol (TEP) involves the immediate delivery of products in a 3:2 ratio of RBC:FFP and 5:1 for RBC:platelets. All patients receiving TEP between February 2006 and January 2008 were compared with a cohort (pre-TEP) of all patients from February 2004 to January 2006 that (1) went immediately to the operating room and (2) received MT (≥10 units of RBC in first 24 hours). Results: Two hundred sixty-four patients met inclusion (125 in the TEP group, 141 in the pre-TEP). Demographics and Injury Severity Score were similar. TEP received more intraoperative FFP and platelets but less in first 24 hours (p < 0.01). There was no difference in renal failure or systemic inflammatory response syndrome, but pneumonia, pulmonary failure, open abdomens, and abdominal compartment syndrome were lower in TEP. In addition, severe sepsis or septic shock and multiorgan failure were both lower in the TEP patients (9{\%} vs. 20{\%}, p = 0.011 and 16{\%} vs. 37{\%}, p < 0.001, respectively). Conclusions: Although MT has been associated with higher organ failure and complication rates, this risk appears to be reduced when blood products are delivered early in the resuscitation through a predefined protocol. Our institution's TEP was associated with a reduction in multiorgan failure and infectious complications, as well as an increase in ventilatorfree days. In addition, implementation ofthis protocol was followed by a dramatic reduction in development of abdominal compartment syndrome and the incidence of open abdomens.",
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