title: Cryoprecipitate use in the PROMMTT study.
abstract: BACKGROUND
  There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival.
  
  
  METHODS
  This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death.
  
  
  RESULTS
  Cryoprecipitate use varied significantly by center, ranging from 7% to 82%. Among patients who received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10-20). The median time from admission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center.
  
  
  CONCLUSIONS
  Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients. We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA. ohn.holcomb@uth.tmc.edu
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Erin E
authors.initials: EE
authors.lastname: Fox
authors.forename: Xuan
authors.initials: X
authors.lastname: Zhang
authors.forename: Nathan
authors.initials: N
authors.lastname: White
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: del Junco
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: Herb A
authors.initials: HA
authors.lastname: Phelan
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: Peter
authors.initials: P
authors.lastname: Muskat
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rahbar
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D016009:Chi-Square Distribution; D005169:Factor VIII / Q000627:therapeutic use*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006470:Hemorrhage / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen