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Volume of Crystalloid During Massive Transfusion Is Associated with Increased Mortality

Summary and Comment |
July 24, 2013

Volume of Crystalloid During Massive Transfusion Is Associated with Increased Mortality

  1. Richard D. Zane, MD, FAAEM

Minimize use of crystalloid during resuscitation in trauma patients.

  1. Richard D. Zane, MD, FAAEM

Multiple studies have demonstrated the benefits of high-ratio resuscitation (1 unit fresh frozen plasma to 1–2 units packed red blood cells) for severely injured trauma patients requiring massive transfusion. In a retrospective multi-institutional study of adult trauma patients who required massive transfusion, researchers compared outcomes between 365 patients who received high-ratio resuscitation and 85 who received low-ratio resuscitation (<1 unit fresh frozen plasma to 2 units packed red blood cells), and assessed the correlation between total crystalloid volume infused and outcomes. All patient received >10 units of packed red blood cells during the first 24 hours.

Patients receiving high-ratio resuscitation had better outcomes than those receiving low-volume resuscitation, consistent with prior studies. A subset of 200 patients who received high-ratio resuscitation and for whom data were available was divided into three groups based on crystalloid volume (<5 L, ≥5–10 L, and >10 L). Higher crystalloid volume was independently associated with increased incidence of bacteremia, adult respiratory distress syndrome, and acute renal failure.

Comment

Many factors affect mortality in patients with major trauma, and this study further implicates volume of crystalloid infusion as a predictor of poor outcomes in patients who require massive transfusion. Trauma patients requiring massive transfusion should receive blood balanced with fresh frozen plasma, and crystalloid volume should be strictly monitored.

  • Disclosures for Richard D. Zane, MD, FAAEM at time of publication Editorial boards Pocket Emergency Medicine

Citation(s):

Reader Comments (2)

PARIS LOVETT Physician, Emergency Medicine

In a capsule review such as this, it would be useful to see some discussion of causation: what evidence in the article or elsewhere deals with the question of whether the correlation between crystalloids and poor outcomes is causative?

MBBS, FMCA (Nigeria) Physician, Anesthesiology, University of Nigeria, Nsukka, Nigeria/FETHA

This is interesting information as I have had to manage patients with obstetric haemorrhage in settings with limited amounts of blood products. In places with limited supply of fresh frozen plasma, which fluid could render similar results? Colloids? And if so, which ones will give similar outcomes.

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