大量输血的异质性定义对使用血液成分阈值预测严重出血创伤患者治疗无效性的影响。

The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients.

作者信息

Thomas Samuel J, Patel Vraj S, Schmitt Connor P, Zielinski Aleksey T, Aboukhaled Mia N, Steinberg Christopher A, Moore Ernest E, Moore Hunter B, Thomas Scott G, Waxman Dan A, Miller Joseph B, Bunch Connor M, Aboukhaled Michael W, Thomas Emmanuel J, Zackariya Saniya K, Oryakhail Halina, Mehreteab Alexander, Ludwig Reagan E, George Sarah M, Siddiqi Aayan I, Zackariya Bilal M, Qasim Aadil, Walsh Mark M, Al-Fadhl Mahmoud D

机构信息

Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA.

Ernest E. Moore Shock Trauma Center, Denver Health, Denver, CO 80204, USA.

出版信息

J Clin Med. 2025 Aug 1;14(15):5426. doi: 10.3390/jcm14155426.

Abstract

In the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further exacerbating current blood product shortages. Previous studies have used various transfusion cut-points per hour to define futility in retrospective analyses but have not accurately defined futility at the bedside due to patient survival even at large rates and volumes of blood transfused. In an attempt to use transfusion cut-points as a marker to help define futility, guidelines have been proposed to limit blood product waste in transfusions for severely bleeding trauma patients, such as Suspension of Transfusion and Other Procedures (STOP) for patients older than 15 and the Futility of Resuscitation Measure (FoRM), used to determine futility in patients older than 60. In an effort to construct effective bedside futile resuscitation criteria with 100% positive predictive value and specificity, this review proposes the use of specific blood component transfusion cut-points combined with parameters from both STOP and FoRM to allow for a comprehensive and accurate method of declaring futility in severely bleeding trauma patients.

摘要

在创伤复苏文献中,对于大量输血和一个单位血液的构成没有一致的定义,这使得使用输血切点来判定治疗无效变得复杂。这是个问题,因为它可能导致血液制品的低效使用,进一步加剧当前血液制品短缺的状况。以往的研究在回顾性分析中使用了每小时不同的输血切点来定义治疗无效,但由于即使大量输血患者仍存活,所以未能在床边准确界定治疗无效。为了将输血切点用作帮助定义治疗无效的指标,已提出一些指南来限制严重出血创伤患者输血时的血液制品浪费,比如针对15岁以上患者的《输血及其他操作中止(STOP)》以及用于判定60岁以上患者治疗无效的《复苏无效衡量标准(FoRM)》。为构建具有100%阳性预测值和特异性的有效的床边无效复苏标准,本综述建议使用特定血液成分输血切点,并结合STOP和FoRM的参数,以便采用一种全面且准确的方法来判定严重出血创伤患者的治疗无效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81c9/12347820/1450822e4621/jcm-14-05426-g001.jpg

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