Reappraising the concept of massive transfusion in trauma.
Crit Care 2010;14(6):R239.
The authors reviewed the records of 5693 patients from 5 trauma registries. They showed an association between transfusion and mortality, with a continuous increase in risk. However, they were unable to identify the traditional 10 units of RBCs (or any other specific threshold) as the definition of massive transfusion based on a mortality outcome. In fact, patients receiving 6-9 units had 2.5 times the mortality of those receiving 0-5 units of RBCs. Thus, management strategies targeted at trauma patients receiving 10 units or more of RBCs will exclude a large proportion of patients who are less transfused but still have significant mortality.
In conclusion, clinicians should attempt to determine if acute traumatic coagulopathy is present and manage the patient accordingly rather than base management on expected transfusion volumes.
– Jean-Franois Hardy