The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: Comparative effectiveness of a time-varying treatment with competing risks
John B. Holcomb,Deborah J. del Junco,Erin E. Fox,Charles E. Wade,Mitchell J. Cohen,Martin A. Schreiber,Louis H. Alarcon,Yu Bai,Karen J. Brasel,Eileen M. Bulger,Bryan A. Cotton,Nena Matijevic,Peter Muskat,John G. Myers,Herb A. Phelan,Christopher E. White,Jiajie Zhang,Mohammad H. Rahbar +17 more
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TLDR
Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission, and among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or Platelet ratios.Abstract:
Objective To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios. Design Prospective cohort study documenting the timing of transfusions during active resuscitation and patient outcomes. Data were analyzed using time-dependent proportional hazards models. Setting Ten US level I trauma centers. Patients Adult trauma patients surviving for 30 minutes after admission who received a transfusion of at least 1 unit of RBCs within 6 hours of admission (n = 1245, the original study group) and at least 3 total units (of RBCs, plasma, or platelets) within 24 hours (n = 905, the analysis group). Main Outcome Measure In-hospital mortality. Results Plasma:RBC and platelet:RBC ratios were not constant during the first 24 hours (P Conclusions Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission. Among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or platelet ratios.read more
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How I treat patients with massive hemorrhage
Pär I. Johansson,Pär I. Johansson,Jakob Stensballe,Roberto S. Oliveri,Charles E. Wade,Sisse R. Ostrowski,John B. Holcomb +6 more
TL;DR: This work presents how hospitals in Copenhagen and Houston, today, manage patients with massive hemorrhage and introduces a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets.
Journal ArticleDOI
Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury.
TL;DR: Future studies of resuscitation and survival after traumatic injury must include analysis of prehospital deaths to fully understand the outcomes of early interventions.
Journal ArticleDOI
Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients.
John B. Holcomb,Daryn P Donathan,Bryan A. Cotton,Deborah J. del Junco,Georgian Brown,Toni von Wenckstern,Jeanette M. Podbielski,Elizabeth A. Camp,Rhonda Hobbs,Yu Bai,Michelle Brito,Elizabeth Hartwell,James R. Duke,Charles E. Wade +13 more
TL;DR: Improved early outcomes are associated with placing blood products prehospital, allowing earlier infusion of life-saving products to critically injured patients, as well as negligible blood products wastage, but not an overall survival advantage.
Journal ArticleDOI
Update on massive transfusion
TL;DR: Current data support that trauma patients treated with higher ratios of plasma and platelet to red blood cell transfusions have improved outcomes, but further clinical investigation is needed.
Journal ArticleDOI
Hemostasis in massively transfused trauma patients
R. B. Counts,Ernest E. Moore +1 more
TL;DR: It is recommended that any patient receiving massive transfusions who develops diffuse microvascular bleeding be given platelet concentrates, and the most useful laboratory test for predicting abnormal bleeding was the platelet count.
References
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Erik von Elm,Douglas G. Altman,Matthias Egger,Matthias Egger,Stuart J. Pocock,Peter C Gøtzsche,Jan P. Vandenbroucke +6 more
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Erik von Elm,Douglas G. Altman,Matthias Egger,Matthias Egger,Stuart J. Pocock,Peter C Gøtzsche,Jan P. Vandenbroucke +6 more
TL;DR: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study, resulting in a checklist of 22 items that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.
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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies
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