Tulane University School of Medicine, New Orleans, Louisiana.
Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana.
Shock. 2021 Dec 1;56(1S):70-78. doi: 10.1097/SHK.0000000000001817.
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.
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.
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).
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.
在过去的十年中，已经实施了许多控制出血和容量替代的进展，这些进展构成了损伤控制性复苏（DCR），以降低出血导致的死亡。我们试图确定在大规模输血方案（MTP）人群中，DCR 干预措施在 12 年内对死亡率的影响。我们假设，随着时间的推移，死亡率会降低，这将需要更多的 DCR 干预措施。
这是对 2008 年至 2019 年在一家大型地区一级创伤中心接受 MTP 治疗的所有 MTP 患者的回顾性分析。检查了实施年份的干预措施，包括 MTP 1:1 比例（2009 年）、液体血浆（2010 年）、氨甲环酸（2012 年）、院前止血带（2013 年）、REBOA/TEG（2017 年）、卫星血站（2018 年）和全血输血（2019 年）。检查了 DCR 干预措施的相对风险和死亡率的几率。
共有 824 名 MTP 患者入组。该队列主要为男性（80.6%），损伤机制为穿透性（68.1%），中位（四分位间距）年龄 31 岁（23-44 岁），新损伤严重程度评分 25 分（16-34 分）。总体死亡率保持不变[（38.3%-56.6%）；P=0.26]。止血带（P=0.02）和全血（WB）（P=0.03）与较低的未调整死亡率相关；仅止血带在调整后仍有意义（OR：0.39；95%CI：0.17-0.89；P=0.03）。
尽管使用止血带和 WB 会降低死亡率，但在我们高 MTP 量的机构中，由于出血导致的死亡率并没有改善，这表明实施新的院内策略不足以降低死亡率。未来的努力应致力于将控制出血和有效复苏干预措施转移到伤处。
