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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Diluting the benefits of hemostatic resuscitation: A multi-institutional analysis
Journal of Trauma and Acute Care Surgery, Volume 75, No. 1, Year 2013
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Description
BACKGROUND: Although minimization of crystalloids is a widely adopted practice in the resuscitation of patients with severe hemorrhage, its direct impact on high-ratio resuscitation (HRR) outcomes has not been analyzed.We hypothesize that HRR patients will have worse outcomes from crystalloid use. METHODS: This was a 4-year retrospective multi-institutional analysis (MIA) of patients who received massive transfusion protocol (MTP) managed with damage-control laparotomy. Ratios of fresh frozen plasmaYpacked red blood cell (PRBC) were calculated and divided in two groups: HRR (1-1:2) and low-ratio resuscitation (LRR G 1:2). Major outcome of interest was to analyze the direct impact of 24-hour crystalloid volume on HRR MTP patients who received 10 or more units of PRBC. Statistical analysis included analysis of variance, Fisher's exact, Kaplan-Meier (KM) survival curves, and multiple logistic regression. RESULTS: Total of five Level I trauma centers participated with 451 patients who received MTP with 10 or more units of PRBC (fresh frozen plasma/PRBC ratios, n = 365 (80.9%) HRR vs. n = 86 (19.0%) LRR. Overall 24-hour KM survival for the HRR versus LRR was 85.2% versus 68.6% ( p = 0.0004). The volume of crystalloids on KM survival curve in HRR MTP patients was not significant for mortality ( p = 0.52). Morbidity odds ratios (95% confidence interval) for complications were not significant for HRR but were for crystalloids: bacteremia, 1.05 (1.0-1.1); adult respiratory distress syndrome, 1.13 (1.0-1.2), and acute renal failure, 1.05 (1.0-1.1). CONCLUSION: Our MIA results support previous studies with decreased mortality in HRR group when compared with LRR. This is the first MIA to demonstrate increased morbidity from crystalloid use in HRR.Within all MTPs with 10 or more units of PRBC, HRR was not a predictor of morbidity, but crystalloid volume was. Caution in overzealous use of crystalloid during HRR is warranted. Copyright © 2013 Lippincott Williams & Wilkins.
Authors & Co-Authors
Duchesne, Juan Carlos
United States, New Orleans
Tulane University School of Medicine
Guidry, Chrissy
United States, Akron
Akron General Hospital
Inaba, Kenji
United States, Los Angeles
University of Southern California
Demetriades, Demetrios G.
United States, Los Angeles
University of Southern California
Holcomb, John Bradley B.
United States, Houston
University of Texas Health Science Center at Houston
Wade, Charles E.W.
United States, Houston
University of Texas Health Science Center at Houston
Statistics
Citations: 78
Authors: 6
Affiliations: 6
Identifiers
Doi:
10.1097/TA.0b013e3182987df3
ISSN:
21630755
Study Design
Cohort Study
Study Approach
Quantitative