Citation

Mitra B, Gabbe BJ, Kaukonen KM, Olaussen A, Cooper DJ, Cameron PA. Shock 2014; 42(4): 307-312.

Affiliation

1Emergency & Trauma Centre, The Alfred Hospital, Melbourne Australia 2 Pre-hospital, Emergency & Trauma Group, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia 3National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia 4 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia 5 Department of Anesthesiology and Intensive Care, Helsinki University Central Hospital, Finland 6 Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne Australia 7 Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.

Copyright

(Copyright © 2014, The Shock Society, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/SHK.0000000000000219

PMID

24978897

Abstract

INTRODUCTION: Resuscitation of patients presenting with haemorrhagic shock after major trauma has evolved to incorporate multiple strategies to maintain tissue perfusion and oxygenation while managing coagulation disorders. We aimed to study changes over time in long-term outcomes in patients with major trauma.

METHODS: A retrospective observational study in a single major trauma centre in Australia was conducted. We included all patients with major trauma and massive blood transfusion within the first 24 hours over a 6-year period (from 2006 to 2011). The main outcome measures were Glasgow Outcome Score - extended (GOSE), and work capacity at 6 and 12 months.

RESULTS: There were 5915 patients with major trauma of which 365 (6.2%; 95% CI: 5.6-6.8) received a massive transfusion. The proportion of major trauma patients receiving massive transfusion decreased over time from 8.2 to 4.4% (p<0.01). There were statistically significant trends towards lower volumes of red cell transfusion and higher ratios of fresh frozen plasma to red cells (p<0.01). Among massively transfused patients, there was no significant change in measured outcomes over the study period with a persistent 23% mortality in hospital, 52% unfavourable GOSE at 6-months and 44% unfavourable GOSE at 12-months. Massive transfusion was independently associated with unfavourable outcomes at 6 months following injury (adjusted OR 1.56; 95% CI: 1.05-2.31), but not at 12months (adjusted OR 0.85; 95% CI: 0.72-1.01).

CONCLUSIONS: A significant reduction in massive transfusion rates was observed. Unfavourable long-term outcomes among patients receiving massive transfusion after trauma were frequent with a substantial proportion of survivors experiencing poor functional status one year after injury.

Language: en