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Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome.
J Trauma. 2008 Apr; 64(4):1010-23.JT

Abstract

BACKGROUND

Severely bleeding trauma patients requiring massive transfusion (MT) often experience poor outcomes. Our purpose was to determine the potential role of near infrared spectrometry derived tissue hemoglobin oxygen saturation (StO2) monitoring in early prediction of MT, and in the identification of those MT patients who will have poor outcomes.

METHODS

Data from a prospective multi-institution StO2 monitoring study were analyzed to determine the current epidemiology of MT (defined as transfusion volume >/=10 units packed red blood cells in 24 hours of hospitalization). Multivariate logistic regression was used to develop prediction models.

RESULTS

Seven US level I trauma centers (TC) enrolled 383 patients. 114 (30%) required MT. MT progressed rapidly (40% exceeded MT threshold 2 hours after TC arrival, 80% after 6 hours). One third of MT patients died. Two thirds of deaths were due to early exsanguination and two thirds of early exsanguination patients died within 6 hours. One third of the early MT survivors developed multiple organ dysfunction syndrome. MT could be predicted with standard, readily available clinical data within 30 minutes and 60 minutes of TC arrival (area under the receiver operating characteristic curve = 0.78 and 0.80). In patients who required MT, StO2 was the only consistent predictor of poor outcome (multiple organ dysfunction syndrome or death).

CONCLUSION

MT progresses rapidly to significant morbidity and mortality despite level I TC care. Patients who require MT can be predicted early, and persistent low StO2 identifies those MT patients destined to have poor outcome. The ultimate goal is to identify these high risk patients as early as possible to test new strategies to improve outcome. Further validation studies are needed to analyze appropriate allocation and study appropriate use of damage control interventions.

Authors+Show Affiliations

Department of Surgery, The Methodist Hospital, Houston Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18404069

Citation

Moore, Frederick A., et al. "Massive Transfusion in Trauma Patients: Tissue Hemoglobin Oxygen Saturation Predicts Poor Outcome." The Journal of Trauma, vol. 64, no. 4, 2008, pp. 1010-23.
Moore FA, Nelson T, McKinley BA, et al. Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. J Trauma. 2008;64(4):1010-23.
Moore, F. A., Nelson, T., McKinley, B. A., Moore, E. E., Nathens, A. B., Rhee, P., Puyana, J. C., Beilman, G. J., & Cohn, S. M. (2008). Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. The Journal of Trauma, 64(4), 1010-23. https://doi.org/10.1097/TA.0b013e31816a2417
Moore FA, et al. Massive Transfusion in Trauma Patients: Tissue Hemoglobin Oxygen Saturation Predicts Poor Outcome. J Trauma. 2008;64(4):1010-23. PubMed PMID: 18404069.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. AU - Moore,Frederick A, AU - Nelson,Teresa, AU - McKinley,Bruce A, AU - Moore,Ernest E, AU - Nathens,Avery B, AU - Rhee,Peter, AU - Puyana,Juan Carlos, AU - Beilman,Gregory J, AU - Cohn,Stephen M, AU - ,, PY - 2008/4/12/pubmed PY - 2008/5/1/medline PY - 2008/4/12/entrez SP - 1010 EP - 23 JF - The Journal of trauma JO - J Trauma VL - 64 IS - 4 N2 - BACKGROUND: Severely bleeding trauma patients requiring massive transfusion (MT) often experience poor outcomes. Our purpose was to determine the potential role of near infrared spectrometry derived tissue hemoglobin oxygen saturation (StO2) monitoring in early prediction of MT, and in the identification of those MT patients who will have poor outcomes. METHODS: Data from a prospective multi-institution StO2 monitoring study were analyzed to determine the current epidemiology of MT (defined as transfusion volume >/=10 units packed red blood cells in 24 hours of hospitalization). Multivariate logistic regression was used to develop prediction models. RESULTS: Seven US level I trauma centers (TC) enrolled 383 patients. 114 (30%) required MT. MT progressed rapidly (40% exceeded MT threshold 2 hours after TC arrival, 80% after 6 hours). One third of MT patients died. Two thirds of deaths were due to early exsanguination and two thirds of early exsanguination patients died within 6 hours. One third of the early MT survivors developed multiple organ dysfunction syndrome. MT could be predicted with standard, readily available clinical data within 30 minutes and 60 minutes of TC arrival (area under the receiver operating characteristic curve = 0.78 and 0.80). In patients who required MT, StO2 was the only consistent predictor of poor outcome (multiple organ dysfunction syndrome or death). CONCLUSION: MT progresses rapidly to significant morbidity and mortality despite level I TC care. Patients who require MT can be predicted early, and persistent low StO2 identifies those MT patients destined to have poor outcome. The ultimate goal is to identify these high risk patients as early as possible to test new strategies to improve outcome. Further validation studies are needed to analyze appropriate allocation and study appropriate use of damage control interventions. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/18404069/Massive_transfusion_in_trauma_patients:_tissue_hemoglobin_oxygen_saturation_predicts_poor_outcome_ L2 - https://doi.org/10.1097/TA.0b013e31816a2417 DB - PRIME DP - Unbound Medicine ER -