Outcomes after massive transfusion in nontrauma patients in the era of damage control resuscitation.
There are little data regarding the use of massive transfusion protocols (MTP) outside of the trauma setting. This study compares the use of an MTP between trauma and non-trauma (NT) patients. Data were collected for trauma and NT patients from the prospectively maintained MTP database  at a Level I trauma center over a 4-year period. Massive transfusion was defined as ≥ 10 units packed red blood cells (PRBCs) in a 24-hour period. Of 439 MTP activations, 37 (8%) were NT patients (64% male; mean age = 51 years, initial base deficit = -10.8). Activations were for gastrointestinal  bleeding (n = 18), bleeding during surgery (n = 13), obstetrical complications (n = 5), and ruptured aortic aneurysm (n = 1). Over-activation of MTP (<10 units PRBCs/24 hours) was higher in NT than trauma patients (19/37, 51% vs 118/284, 29%, P < 0.01). For massive transfusion  patients, 24-hour mortality was higher in NT compared with trauma patients (10/17, 59% vs 100/284, 35%, P = 0.05), but there was no difference in 30-day mortality (10/17, 59% vs 144/284, 51%, P = 0.51). With over-activation in 51% of NT patients, MTP usage outside  of trauma is inefficient. Outcomes in NT patients were worse than trauma patients, which may be related to the underlying disease processes.
Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA. bcmorse@ghs.org
Bryan C
BC
Morse
Christopher J
CJ
Dente
Erica I
EI
Hodgman
Beth H
BH
Shaz
Anne
A
Winkler
Jeffrey M
JM
Nicholas
Amy D
AD
Wyrzykowski
Grace S
GS
Rozycki
David V
DV
Feliciano
D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006470:Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy