Trauma/Critical CareIdeal hemoglobin transfusion target for resuscitation of massive-transfusion patients
Section snippets
Methods
Institutional review board approval was obtained to review the medical records of operative and trauma patients who underwent MT between 2010 and 2013 at a single institution. Patients who underwent a cardiac operation or required cardiopulmonary bypass were excluded. The HgB value obtained 24 ± 6 hours after anatomic hemostasis, defined as the time point of the last (tenth or higher) consecutive pRBC transfusion followed by no pRBC transfusions for at least 6 hours, was used to stratify
Results
In total, 547 MT patients survived to the 24-hour time point; of these patients, 129 were excluded due to undergoing a cardiac operation or cardiopulmonary bypass. Therefore, 418 patients were included in the analysis. The cohort was heterogeneous and made up of 39% general surgery, 13% trauma, 12% spine, 9% vascular, 8% liver transplant, 6% orthopedics, 5% urology, 3% noncardiac thoracic, 3% oral-maxillofacial, 2% neurosurgery, and 0.3% kidney/pancreas transplant patients (Table I).
Overall,
Discussion
The results of this study represent an initial attempt at defining optimal blood product transfusion practice for hemorrhage resuscitation. HgB values between 8.0 and 11.9 g/dL 24 hours after anatomic hemostasis provided the lowest odds of death in massively hemorrhaging patients when controlled for potential confounders. Not surprisingly, UT patients had the greatest mortality odds but, more significantly, the data demonstrated that OT patients had substantially increased odds of death, which
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Supported by CTSA grant number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
The authors declare no conflicts of interest relevant to this research.