Gaitanidis Apostolos, Sinyard Robert T, Nederpelt Charlie J, Maurer Lydia R, Christensen Mathias A, Mashbari Hassan, Velmahos George C, Kaafarani Haytham M A
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts.
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
J Surg Res. 2022 Jan;269:94-102. doi: 10.1016/j.jss.2021.07.027. Epub 2021 Sep 16.
Balanced blood product transfusion improves the outcomes of trauma patients with exsanguinating hemorrhage, but it remains unclear whether administering cryoprecipitate improves mortality. We aimed to examine the impact of early cryoprecipitate transfusion on the outcomes of the trauma patients needing massive transfusion (MT).
All MT patients 18 years or older in the 2017 Trauma Quality Improvement Program (TQIP) were retrospectively reviewed. MT was defined as the transfusion of ≥10 units of blood within 24 hours. Propensity score analysis (PSA) was used to 1:1 match then compare patients who received and those who did not receive cryoprecipitate in the first 4 hours after injury. Outcomes included in-hospital mortality, 1-day mortality, in-hospital complications and transfusion needs at 24 hours.
Of 1,004,440 trauma patients, 1,454 MT patients received cryoprecipitate and 2,920 did not. After PSA, 877 patients receiving cryoprecipitate were matched to 877 patients who did not. In-hospital mortality was lower among patients who received cryoprecipitate (49.4% v. 54.9%, P = 0.022), as was 1-day mortality. Sub-analyses showed that mortality was lower with cryoprecipitate in patients with penetrating (37.5% versus. 48%, adjusted P = 0.008), but not blunt trauma (58.5% versus. 59.8%, adjusted P = 1.000). In penetrating trauma, the cryoprecipitate group also had lower 1-day mortality (21.8% versus. 38.6%, P <0.001) and a higher rate of hemorrhage control surgeries performed within 24 hours (71.4% versus. 63.3%, P = 0.018).
Cryoprecipitate in MT is associated with improved survival in penetrating, but not blunt, trauma. Randomized trials are needed to better define the role of cryoprecipitate in MT.
平衡输血可改善创伤性大出血患者的预后，但输注冷沉淀是否能降低死亡率仍不明确。我们旨在研究早期输注冷沉淀对需要大量输血（MT）的创伤患者预后的影响。
对2017年创伤质量改进计划（TQIP）中所有18岁及以上的MT患者进行回顾性研究。MT定义为在24小时内输注≥10单位血液。采用倾向评分分析（PSA）进行1:1匹配，然后比较受伤后4小时内接受和未接受冷沉淀的患者。结局指标包括住院死亡率、1天死亡率、住院并发症以及24小时的输血需求。
在1,004,440例创伤患者中，1,454例MT患者接受了冷沉淀，2,920例未接受。经过PSA后，877例接受冷沉淀的患者与877例未接受的患者进行了匹配。接受冷沉淀的患者住院死亡率较低（49.4%对54.9%，P = 0.022），1天死亡率也是如此。亚组分析显示，穿透伤患者接受冷沉淀后死亡率较低（37.5%对48%，校正P = 0.008），但钝性创伤患者并非如此（58.5%对59.8%，校正P = 1.000）。在穿透伤中，冷沉淀组1天死亡率也较低（21.8%对38.6%，P <0.001），且24小时内进行出血控制手术的比例较高（71.4%对63.3%，P = 0.018）。
MT中冷沉淀与穿透伤而非钝性创伤患者生存率的提高相关。需要进行随机试验以更好地确定冷沉淀在MT中的作用。
