After 800 MTP Events, Mortality due To Hemorrhagic Shock Remains High And Unchanged Despite Several In-Hospital Hemorrhage Control Advancements
| Autor: | Clifton McGinness, Robert Reily, Patrick McGrew, Chrissy Guidry, Juan Duchesne, Charles Harris, Scott Ninokawa, Danielle Tatum, Rebecca Schroll, Sharven Taghavi |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation Population Shock Hemorrhagic Critical Care and Intensive Care Medicine Young Adult Trauma Centers Interquartile range medicine Humans Blood Transfusion education Retrospective Studies education.field_of_study Hemostatic Techniques business.industry Mortality rate Trauma center Tourniquets Louisiana Antifibrinolytic Agents Tranexamic Acid Relative risk Emergency medicine Emergency Medicine Wounds and Injuries Injury Severity Score Female business Tranexamic acid medicine.drug |
| Zdroj: | Shock. |
| ISSN: | 1073-2322 |
| DOI: | 10.1097/shk.0000000000001817 |
| Popis: | BACKGROUND Numerous advancements in hemorrhage control and volume replacement that comprise damage control resuscitation (DCR) have been implemented in the last decade to reduce deaths from bleeding. We sought to determine the impact of DCR interventions on mortality over 12 years in a massive transfusion protocol (MTP) population. We hypothesized that mortality would be decreased in later years, which would have used more DCR interventions. STUDY DESIGN This was a retrospective review of all MTP patients treated at a large regional Level I trauma center from 2008 to 2019. Interventions by year of implementation examined included MTP 1:1 ratio (2009), liquid plasma (2010), tranexamic acid (2012), prehospital tourniquets (2013), REBOA/TEG (2017), satellite blood station (2018), and whole blood transfusion (2019). Relative risk and odds of mortality for DCR interventions were examined. RESULTS There were 824 MTP patients included. The cohort was primarily male (80.6%) injured by penetrating mechanism (68.1%) with median (interquartile range) age 31 years (23-44) and New Injury Severity Score 25 (16-34). Overall mortality was unchanged [(38.3%-56.6%); P = 0.26]. Tourniquets (P = 0.02) and whole blood (WB) (P = 0.03) were associated with lower unadjusted mortality; only tourniquets remained significant after adjustment (OR: 0.39; 95% CI: 0.17-0.89; P = 0.03). CONCLUSIONS Despite lower mortality with use of tourniquets and WB, mortality rates due to hemorrhage have not improved at our high MTP volume institution, suggesting implementation of new in-hospital strategies is insufficient to reduce mortality. Future efforts should be directed toward moving hemorrhage control and effective resuscitation interventions to the injury scene. |
| Databáze: | OpenAIRE |
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