Improved survival following massive transfusion in patients who have undergone trauma

Hypothesis: Survival following massive transfusion in patients who have und ergone trauma has improved during the past 10 years. Design: Retrospective cohort study. Setting: Academic level I trauma center in an urban community. Patients: All patients who underwent trauma and who received greater than 5 0 U of packed red blood cells or whole blood in the 48 hours following admi ssion to the emergency department. Interventions: Data were obtained from blood bank records, the trauma regis try, patient medical records, and hospital purchasing records. Patients wer e divided into 2 groups for comparison (early [1988-1992] and late [1993-19 97] periods). Main Outcome Measures: Survival and changes in trauma care provision. Results: Survival following massive transfusion in patients who have underg one trauma has significantly increased during the past 10 years (16% vs 45% , early vs late period, P=.03). Factors associated with poor outcome includ ed male sex, major vascular injury, high Injury Severity Score, severe acid osis, prolonged hypotension, refractory hypothermia, and decreased use of p latelet transfusion (all P<.05). In the later period, there was more aggres sive correction of coagulopathy, more efficient use of warming measures, de creased operative times for the initial operation, and increased use of com ponent therapy tall P<.05). Conclusions: Survival following massive transfusion has significantly (P=.0 3) increased during the past 10 years. Factors that may have contributed to this include more effective and efficient rewarming procedures, improved a pplication of damage control techniques, more aggressive correction of coag ulopathy, and improved blood banking procedures.