Dataset Information

Staying on target: Maintaining a balanced resuscitation during damage-control resuscitation improves survival.

ABSTRACT:

Background

Damage-control resuscitation (DCR) improves survival in severely bleeding patients. However, deviating from balanced transfusion ratios during a resuscitation may limit this benefit. We hypothesized that maintaining a balanced resuscitation during DCR is independently associated with improved survival.

Methods

This was a secondary analysis of the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients receiving >3 U of packed red blood cells (PRBCs) during any 1-hour period over the first 6 hours and surviving beyond 30 minutes were included. Linear regression assessed the effect of percent time in a high-ratio range on 24-hour survival. We identified an optimal ratio and percent of time above the target ratio threshold by Youden's index. We compared patients with a 6-hour ratio above the target and above the percent time threshold (on-target) with all others (off-target). Kaplan-Meier analysis assessed the combined effect of blood product ratio and percent time over the target ratio on 24-hour and 30-day survival. Multivariable logistic regression identified factors independently associated with 24-hour and 30-day survival.

Results

Of 1,245 PROMMTT patients, 524 met the inclusion criteria. Optimal targets were plasma/PRBC and platelet/PRBC of 0.75 (3:4) and ≥40% time spent over this threshold. For plasma/PRBC, on-target (n = 213) versus off-target (n = 311) patients were younger (median, 31 years; interquartile range, [22-50] vs. 40 [25-54]; p = 0.002) with similar injury burdens and presenting physiology. Similar patterns were observed for platelet/PRBC on-target (n = 116) and off-target (n = 408) patients. After adjusting for differences, on-target plasma/PRBC patients had significantly improved 24-hour (odds ratio, 2.25; 95% confidence interval, 1.20-4.23) and 30-day (odds ratio, 1.97; 95% confidence interval, 1.14-3.41) survival, while on-target platelet/PRBC patients did not.

Conclusion

Maintaining a high ratio of plasma/PRBC during DCR is independently associated with improved survival. Performance improvement efforts and prospective studies should capture time spent in a high-ratio range.

Level of evidence

Epidemiologic/prognostic study, level II; Therapeutic, level IV.

SUBMITTER: Hynes AM

PROVIDER: S-EPMC8547746 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Staying on target: Maintaining a balanced resuscitation during damage-control resuscitation improves survival.

Hynes Allyson M AM Geng Zhi Z Schmulevich Daniela D Fox Erin E EE Meador Christopher L CL Scantling Dane R DR Holena Daniel N DN Abella Benjamin S BS Young Andrew J AJ Holland Sara S Cacchione Pamela Z PZ Wade Charles E CE Cannon Jeremy W JW

The journal of trauma and acute care surgery 20211101 5

<h4>Background</h4>Damage-control resuscitation (DCR) improves survival in severely bleeding patients. However, deviating from balanced transfusion ratios during a resuscitation may limit this benefit. We hypothesized that maintaining a balanced resuscitation during DCR is independently associated with improved survival.<h4>Methods</h4>This was a secondary analysis of the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients receiving >3 U of packed red blood c ...[more]

PMID: 33901052

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Dataset Information

Staying on target: Maintaining a balanced resuscitation during damage-control resuscitation improves survival.

Background

Methods

Results

Conclusion

Level of evidence

Publications

Staying on target: Maintaining a balanced resuscitation during damage-control resuscitation improves survival.

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