A Leg Up: Evaluating Ultramassive Transfusion after Extremity Vascular Injury

Document Type

Article

Publication Date

9-3-2025

Publication Title

Journal of the American College of Surgeons

Abstract

INTRODUCTION: Extremity vascular injuries (EVI) are rare, life-threatening injuries that may require ultra-massive transfusion (UMT), defined as transfusion of ≥ 20 units of red cell products in 24 hours. This study aimed to evaluate outcomes of patients with EVI who required UMT and to determine which variables are associated with survival. METHODS: A retrospective, multicenter analysis from eleven high-volume trauma centers was conducted of trauma patients who received UMT from 2016-2024. Demographic, clinical, and outcome data were obtained and compared between patients with/without an EVI with subgroup analysis based on mortality. RESULTS: 1,155 patients received UMT and 194 (16.8%) had an EVI. The majority (62.4%) of these injuries were penetrating, and those with an EVI had a lower Injury Severity Score (ISS) (30 vs. 34, p < 0.01), underwent fewer resuscitative thoracotomies (19.1 vs. 24.9%, p=0.02), and fewer exploratory laparotomies (61.3 vs. 82.7%, p < 0.01). Of all EVI patients, 79 patients (40.7%) had an isolated EVI. More than half of patients with an EVI survived compared to only a third without an EVI (50.5 vs. 33.3%, p < 0.01). There was no difference in the transfusion of blood products. Among EVI patients, survivors had a lower ISS (27 vs. 33, p < 0.01), higher initial heart rate (111 vs. 87 beats per minute, p < 0.01), higher Glasgow Coma Scale score (10 vs. 7, p< 0.01), higher initial platelet count (169 vs. 140 103/mcL, p = 0.02), lower lactate (8.2 vs. 12.5 mmol/L, p < 0.01), and smaller base deficit (11.5 vs. 16.1 mmol/L, p < 0.01). CONCLUSION: In patients who require UMT, EVI is associated with a higher rate of survival compared to those without EVI.

First Page

1

Last Page

23

PubMed ID

40899718

Rights

© 2025 by the American College of Surgeons

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