Objective: To examine the hypothesis that the futility of short-term c
are for trauma patients requiring emergency operation can be determine
d based on the number of units of blood transfused and associated risk
factors. Design: A 4-year retrospective review of a cohort of critica
lly injured patients who underwent an emergency operation. Setting: A
large-volume, academic level I, urban trauma center. Patients: One hun
dred forty-one consecutive patients received massive blood transfusion
s of 20 U or more of blood during preoperative and intraoperative resu
scitation (highest, 68 U). There were 43 survivors (30.5%) and 98 nons
urvivors (69.5%). Main Outcome Measures: Mortality. Results: The numbe
r of blood units transfused did not differ between survivors and nonsu
rvivors (mean +/- SD,31 +/- II vs 32 +/- 10; P = .52). Stepwise multip
le regression analysis identified 3 independent variables associated w
ith mortality: need for aortic clamping, intraoperative use of inotrop
es, and intraoperative time with a systolic blood pressure of 90 mm Hg
or less; However, blood usage was not different among the subgroups o
f patients who had 1 or more of these risk factors. When patients were
stratified according to the amount of massive blood transfusion (20-2
9, 30-39, 40-49, and 50-68 U), the incidence of risk factors was not d
ifferent across the 4 subgroups. Survival in the presence of risk fact
ors was not affected by the amount of blood transfused. Conclusions: A
lthough mortality among critically injured patients requiring operatio
n and massive blood transfusion can be correlated with independent ris
k factors, discontinuation of short-term care cannot be justified base
d on the need for massive blood transfusion of up to 68 units.