Filling the tank: A multicenter investigation of trauma survival after ultramassive transfusion

Authors

Zachary J. Grady, Emory University School of Medicine, Atlanta, Georgia
Jonathan Nguyen, Emory University School of Medicine, Atlanta, Georgia
Courtney H. Meyer, Emory University School of Medicine, Atlanta, Georgia
Tim P. Moran, Morehouse School of Medicine, Atlanta, Georgia; Department of Emergency Medicine
Marta Rowh, Morehouse School of Medicine, Atlanta, Georgia; Department of Emergency Medicine
Ashling Zhang, Emory University School of Medicine, Atlanta, Georgia; Department of Surgery
Melike N. Harfouche, Emory University School of Medicine, Atlanta, Georgia; Department of Surgery
Patrick Greiffenstein, LSU Health Sciences Center - New OrleansFollow
Sophia Trinh, LSU Health Sciences Center - New OrleansFollow
Kenji Inaba, Keck Medicine of USC, Los Angeles, California
Negar Nekooei, Keck Medicine of USC, Los Angeles, California
Dina M. Filiberto, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery
Caitlin E. Jones Sayyid, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery
Adam Gutierrez, University of Miami, Miami, Florida
Jonathan P. Meizoso, University of Miami, Miami, Florida
William B. Risinger
Jason W. Smith, University of Louisville, Louisville, Kentucky
Christina L. Jacovides, Temple University Hospital, Philadelphia, Pennsylvania
Evan D. Trausch, Temple University, Philadelphia, Pennsylvania
Allison G. McNickle, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
Athriya Kumar, utgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
Rachel L. Choron, utgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
Samuel Wade Ross, Carolinas Medical Center, Charlotte, North Carolina
Van Christian Sanderfer, Carolinas Medical Center, Charlotte, North Carolina
Jason Sciarretta
Randi N. Smith, Emory University School of Medicine, Atlanta, Georgia

Document Type

Article

Publication Date

5-13-2025

Publication Title

The journal of trauma and acute care surgery

Abstract

INTRODUCTION: Ultramassive transfusion (UMT), transfusion of ≥ 20U of red blood cell products in the first 24 hours, is rare, requires significant resource utilization, and is associated with high mortality. The aim of this study was to describe the characteristics of trauma patients undergoing UMT and determine patterns associated with survival after UMT. METHODS: This retrospective, multicenter analysis from 11 high-volume trauma centers included traumatically injured patients older than 14 years who received UMT from 2016 to 2024. Demographic, clinical, and outcome data were obtained and compared between survivors and nonsurvivors. The primary outcome was survival with secondary outcome of need for specific operative interventions. RESULTS: A total of 1,155 patients received UMT with a mortality rate of 62.9%. Between survivors and nonsurvivors, there was no difference in mechanism of injury. Survivors presented were tachycardic (120 vs. 98 beats per minute, p < 0.001) and had a higher initial Glasgow Coma Scale score (14 vs. 3, p < 0.001), higher initial platelet count (189 vs. 149 103/μL, p < 0.001), and smaller initial base deficit (8 vs. 11.8 mmol/L, p < 0.001). Survivors underwent more extremity explorations (25.2% vs. 14.4%, p < 0.001) and had more extremity vascular injuries (22.9% vs. 13.2%, p < 0.001). The odds of mortality increased with age (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.015-1.037; p < 0.001), Injury Severity Score (OR, 1.025; 95% CI, 1.013-1.036; p < 0.001), initial lactate (OR, 1.119; 95% CI, 1.079-1.161; p < 0.001), and emergency department thoracotomy (OR, 3.92; 95% CI, 2.129-7.223; p < 0.001). The odds of mortality decreased with higher Glasgow Coma Scale score (OR, 0.93; 95% CI, 0.897-0.962; p < 0.001), heart rate (OR, 0.995; 95% CI, 0.990-0.9997; p = 0.04), and initial platelet count (OR, 0.998; 95% CI, 0.996-0.999; p = 0.04). CONCLUSION: This study affirms known factors influencing mortality in UMT and describes new patterns associated with reduced mortality including higher initial heart rate, extremity exploration, and concomitant extremity vascular injury. These findings can inform clinical decision making in the care of this challenging patient population. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

PubMed ID

40358603

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