Blood Product Utilization In Emergency Resuscitative Thoracotomy: A Nationwide Analysis
*Vahe S. Panossian MD, *Ikemsinachi Nzenwa , *Anne Hoekman , *Emanuele Lagazzi , *Wardah Rafaqat , *Suzanne Arnold , *Majed El Hechi , *Josh Ng-Kamstra , *Matthew Bartek , *Charu Paranjape , *Michael DeWane , *John Hwabejire , George Velmahos , Haytham Kaafarani MD, MPH
Massachusetts General Hospital, Boston, MA
Background: Emergency resuscitative thoracotomy (ERT) survival ranges between zero in blunt injury patients arriving with no signs of life (SOL) to more than 40% in select penetrating injury patients with SOL. Given this wide prognostic range and global shortages of blood products, we sought to stratify blood utilization across this patient population.
Study Design: We identified patients in ACS-TQIP (2017-2019) undergoing an ERT within 30 minutes of arrival to the hospital and stratified them by the mechanism of injury and presence of SOL on arrival. No SOL was defined as cardiopulmonary resuscitation in progress on arrival. The primary outcome was the number of packed red blood cells (pRBCs) units transfused within 4 hours. Secondary outcomes were overall survival and the number of pRBC units needed to be transfused (NNT) to observe one survivor.
Results: A total of 1,523 patients were included. The median age was 35.8, 84.8% were male, 70.3% had penetrating trauma, and 47.5% presented with SOL. The overall survival rate was 10.7%, and the median number of pRBCs transfused within 4 hours was 4.3 [IQR: 1.4-12]. Figure 1 describes the mortality and the median number of pRBCs transfused across patients with different mechanisms of injury with and without SOL. Penetrating trauma patients with SOL had a survival rate of 26% and received a median of 9.0 [4.0-16.5] pRBCs. Blunt trauma patients presenting with no SOL had a 1.1% survival and received a median of 2.3 pRBCs [0.9-6.9]. For SW patients arriving with SOL, a total number of 16 pRBC units were transfused to observe one survivor. For blunt trauma patients without SOL, a total of 546 units were transfused to observe one survivor (Figure 2).
Conclusion: Given the futility of ERT in blunt trauma patients presenting with no SOL and the ongoing national shortage of blood, we recommend allocating these precious resources exclusively to penetrating trauma patients and to blunt trauma patients presenting with SOL.
Figure 1: Median [IQR] number of pRBC Units Transfused within 4 Hours Based on Injury Mechanism and Signs of Life.
Figure 2: Number of Units Needed to be Transfused (NNT) for One Patient to Survive Based on Mechanism of Injury and Signs of Life on Arrival
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