Cause and timing of death in massively transfused trauma patients.
Cause and timing of death in massively transfused trauma patients.
复制标题
DOI：
10.1097/ta.0b013e31829a24b4
复制
发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Cohen MJ
中科院分区：
文献类型：
--
作者：
Cripps MW;Kutcher ME;Daley A;McCreery RC;Greenberg MD;Cachola LM;Redick BJ;Nelson MF;Cohen MJ
本研究的目的是描述严重创伤患者的死亡原因，以确定对复苏的潜在反应。对190例接受大量输血方案激活（MTP）或大量输血（MT；超过10单位的红细胞(pRBC)/24小时）的危重伤员进行前瞻性分析。死因可分为四类：1)失血过多，2)早期生理性衰竭，3)晚期生理性衰竭，4)无法存活的伤害。190例患者接受MT或MTP治疗，76例死亡（40%死亡率），其中72例死亡属于以下四类之一：33.3%死于失血过多，16.6%死于早期生理性衰竭，11.1%死于晚期生理性衰竭，38.8%死于无法存活的损伤。尽管早期生理性崩溃组存活时间足够长，可以使用最多的血液制品（p<0.001），但死于失血的患者年龄较小，RBC:FFP比值最高（2.97±2.24）。晚期生理性塌陷组穿透性损伤明显减少，年龄较大，晶体使用明显增多，但RBC:FFP比值较低（1.50±0.42）。那些被确定有不可存活性损伤的患者有较低的GCS，较少的穿透性损伤和较高的初始血压，这反映了不可存活性创伤性脑损伤的优势。潜在可存活损伤患者的平均生存时间为2.4小时，而不可存活损伤患者的平均生存时间为18.4小时（p<0.001）。需要MTP治疗的严重受伤患者死亡率高。然而，迄今为止还没有研究涉及MTP后的死亡原因。对死亡原因的定性将使手术和复苏行为成为可能，从而延长生理储备时间，从而使以前无法存活的损伤有可能存活下来。预后研究，III级
The purpose of this study was to characterize the cause of death in severely injured trauma patients in order to define potential responses to resuscitation. Prospective analysis of 190 critically-injured patients who underwent massive transfusion protocol activation (MTP) or received massive transfusion (MT; greater than 10 units of packed red blood cells (pRBC)/24 hours). Cause of death was adjudicated into one of four categories: 1) Exsanguination, 2) Early physiologic collapse, 3) Late physiologic collapse, and 4) Non-survivable injury. 190 patients underwent MT or MTP with 76 deaths (40% mortality) of which 72 deaths were adjudicated to one of four categories: 33.3% died from exsanguination, 16.6% died from early physiologic collapse, 11.1% died from late physiologic collapse, while 38.8% died from non-survivable injuries. Patients who died from exsanguination were younger and had the highest RBC:FFP ratio (2.97 ± 2.24), although the early physiologic collapse group survived long enough to use the most blood products (p<0.001). The late physiologic collapse group had significantly fewer penetrating injuries, was older, and had significantly more crystalloid use, but received a lower RBC:FFP ratio (1.50 ± 0.42). Those who were determined to have a non-survivable injury had a lower presenting GCS, fewer penetrating injuries, and higher initial blood pressure reflecting a preponderance of non-survivable traumatic brain injury. The average survival time for patients with potentially survivable injuries was 2.4 hrs versus 18.4 hours for non-survivable injuries (p<0.001). Severely injured patients requiring MTP have a high mortality rate. However, no studies to date have addressed the cause of death after MTP. Characterization of cause of death will allow targeting of surgical and resuscitative conduct to allow extension of the physiologic reserve time therefore rendering previously non-survivable injury potentially survivable. Prognostic study, Level III