title: Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome.
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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Surgery, The Methodist Hospital, Houston Texas, USA.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.forename: Teresa
authors.initials: T
authors.lastname: Nelson
authors.forename: Bruce A
authors.initials: BA
authors.lastname: McKinley
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Puyana
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009102:Multiple Organ Failure / Q000517:prevention & control*; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D006454:Hemoglobins