Hypocalcemia in trauma patients receiving massive transfusion
| Autor: | Rodrigo F. Alban, Brandon Hobbs, Xi Liu-DeRyke, Amanda Giancarelli, Kara L. Birrer |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male endocrine system medicine.medical_specialty Resuscitation Blood transfusion Adolescent endocrine system diseases medicine.medical_treatment 030204 cardiovascular system & hematology Severity of Illness Index Young Adult 03 medical and health sciences 0302 clinical medicine Primary outcome medicine Humans Blood Transfusion Aged Retrospective Studies Aged 80 and over Calcium metabolism Hypocalcemia business.industry Incidence Incidence (epidemiology) Transfusion Reaction nutritional and metabolic diseases 030208 emergency & critical care medicine Retrospective cohort study Middle Aged Massive transfusion Surgery ROC Curve Anesthesia Wounds and Injuries Female Trauma resuscitation business hormones hormone substitutes and hormone antagonists |
| Zdroj: | Journal of Surgical Research. 202:182-187 |
| ISSN: | 0022-4804 |
| Popis: | Massive transfusion protocol (MTP) is increasingly used in civilian trauma resuscitation. Calcium is vital for coagulation, but hypocalcemia commonly occurs during massive transfusion due to citrate and serum calcium chelation. This study was conducted to determine the incidence of hypocalcemia and severe hypocalcemia in trauma patients who receive massive transfusion and to compare characteristics of patients with severe versus nonsevere hypocalcemia.This was a retrospective study of trauma patients who received massive transfusion between January 2009 and November 2013. The primary outcome was the incidence of hypocalcemia (ionized calcium [iCa]1.12 mmol/L) and severe hypocalcemia (iCa0.90 mmol/L). Secondary outcomes included calcium monitoring, calcium replacement, and correction of coagulopathy.There were 156 patients included; 152 (97%) experienced hypocalcemia, and 111 (71%) had severe hypocalcemia. Patients were stratified into iCa ≥ 0.90 (n = 45) and iCa0.90 (n = 111). There were no differences in demographics or baseline laboratories except the severe hypocalcemia group had higher baseline activated partial thromboplastin time (29.7 [23.7-50.9] versus 25.8 [22.3-35.9], P = 0.003), higher lactic acid (5.8 [4.1-9.8] versus 4.0 [3.1-7.8], P = 0.019), lower platelets (176 [108-237] versus 208 [169-272], P = 0.003), and lower pH (7.14 [6.98-7.28] versus 7.23 [7.14-7.33], P = 0.019). Mortality was higher in the severe hypocalcemia group (49% versus 24%, P = 0.007). Patients in the iCa0.90 group received more blood products (34 [23-58] versus 22 [18-30] units, P0.001), and calcium chloride (4 [2-7] versus 3 [1-4] g, P = 0.002), but there was no difference in duration of MTP or final iCa. Neither group reached a median iCa1.12.Hypocalcemia is common during MTP, and vigilant monitoring is warranted. Research is needed to effectively manage hypocalcemia during massive transfusion. |
| Databáze: | OpenAIRE |
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