The impact of a massive transfusion protocol on outcomes among patients with abdominal aortic injuries.
BACKGROUND
Injuries of the abdominal aorta are uncommon and associated with a high mortality. The purpose of this study was to examine the impact of an institutional massive transfusion protocol (MTP) on outcomes in patients with injuries of the abdominal aorta.


METHODS
A 12.5-year retrospective analysis of a Level 1 trauma center database to identify patients with abdominal aortic injuries was conducted. Demographics, associated injuries and severity, operative procedures, resuscitation requirements, and outcomes were compared among patients before and after implementation of an MTP.


RESULTS
Of the 46 patients with abdominal aortic injuries, 29 (63%) were in the pre-MTP group and 17 (37%) were in the post-MTP group. The mean age of the entire cohort was 32 ± 17 years and the two most common mechanisms of injury were gunshot wounds (63%) followed by motor vehicle collisions (24%). Thirteen patients (28%) underwent an emergency department thoracotomy and 11 patients (24%) sustained concomitant inferior vena cava injuries. There was a significant reduction in the volume of pre- and intraoperative crystalloids administered between the pre- and post-MTP groups. Intraoperatively, the use of tranexamic acid was increased in the post-MTP group (P < 0.001). A statistically significant difference in achievement of a low packed red blood cells to fresh frozen plasma ratio was observed for the post- versus the pre-MTP group (88% vs. 30%, P = 0.015). Overall survival was improved among post- versus pre-MTP patients (47% vs. 14%, P = 0.03).


CONCLUSIONS
Abdominal aortic injuries continue to represent a challenge and remain associated with a high mortality. Modern improvements in damage control resuscitation techniques including implementation of an institutional MTP may improve outcomes in patients with these injuries.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
James D
JD
Maciel
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
Edward
E
Gifford
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
David
D
Plurad
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA.
Christian
C
de Virgilio
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Scott
S
Bricker
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Fred
F
Bongard
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Angela
A
Neville
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Jennifer
J
Smith
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Brant
B
Putnam
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA. Electronic address: dekim@dhs.lacounty.gov.
Dennis
D
Kim
D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001012:Aorta, Abdominal / Q000293:injuries / Q000601:surgery*; D001803:Blood Transfusion / Q000379:methods* / Q000401:mortality; D002140:California; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage; D065227:Transfusion Reaction; D014193:Trauma Centers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid