Skip to main content

No impact of a massive transfusion protocol on coagulopathy and mortality at a level 1 trauma center: why?

Introduction

In 2010 we studied the mortality and coagulopathy of all massively transfused patients at our hospital since 2004. We compared those who were transfused before the implementation of our massive transfusion protocol (MTP) (from 2004 to 2006) to those transfused with MTP. We found that our MTP did not lower mortality (35.7%) and our incidence of coagulopathy was high (72.6%). The aim of the present study is to explain those results, while concentrating uniquely on trauma patients.

Methods

We conducted a retrospective nested case-control study from our trauma registry. We included trauma patients who received 10 packed red blood cells (pRBC) or more in 24 hours and excluded those who died within the very first hours of massive trauma. We extracted supplementary demographic and clinical data from the laboratory database and the hospital files. Chi-square tests and multivariate logistic regression were used to compare the effect of the two approaches (MTP vs. non-MTP) on mortality and coagulopathy, defined as an INR ≥1.8, a PTT ≥54, a fibrinogen <1 g/l or a platelet count <50,000, while controlling for acidosis (defined as a pH ≤7.1), hypothermia (defined as ≤35°C) and Injury Severity Score (ISS) (critically injured if ISS ≥30).

Results

Of the 84 trauma patients, 23 were transfused with the MTP and 61 without. The average ISS score was very high (29.2), most were male (73.8%) and the average age was 41 years. The MTP versus non-MTP groups were similar in regards to age, sex, pH, temperature, ISS and Revised Trauma Score, but the MTP group received more transfusions (40% vs. 22% when dichotomized in two groups: above 20 pRBC and between 10 and 20 pRBC). The mortality and coagulopathy were similar in both the MTP and non-MTP group (39% vs. 34% and 65% vs. 75% respectively). PTM did not affect mortality or coagulopathy, even when controlling for all other variables. Individually, both hypothermia (OR = 2.6, 95% CI: 1.1 to 6.8) and acidosis (OR = 4.3, 95% CI:1.6 to 13.0) significantly affected mortality, while the number of pRBC (OR = 3.8, 95% CI: 1.1 to 14.1) was the main determinate for coagulopathy.

Conclusion

In our population of severely injured patients, the MTP was not found to be beneficial in regards to mortality nor coagulopathy. Hypothermia and acidosis seem to be the main determinants for mortality and should be among the priorities in caring for trauma patients.

References

  1. 1.

    Cotton BA, et al.: J Trauma. 2009, 66: 41-49. 10.1097/TA.0b013e31819313bb

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to C Bourassa-Fulop.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Bourassa-Fulop, C., Chauny, J., Paquet, J. et al. No impact of a massive transfusion protocol on coagulopathy and mortality at a level 1 trauma center: why?. Crit Care 16, P444 (2012). https://doi.org/10.1186/cc11051

Download citation

Keywords

  • Platelet Count
  • Fibrinogen
  • Trauma Patient
  • Injury Severity Score
  • Trauma Center