Massive Transfusion in Cardiac Surgery: The Impact of Blood Component Ratios on Clinical Outcomes and Survival.

摘要: Background Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of after injury suggest that ratios administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from Red Cell Storage Duration Study (RECESS), a large randomized trial effect RBC storage duration patients undergoing complex cardiac surgery, were analyzed retrospectively investigate association between component used massively transfused subsequent clinical outcomes. Methods Massive was defined as those who had ≥6 units or ≥8 total components. For plasma, high ratio ≥1 unit:1 unit. PLT transfusion, ≥0.2 doses:1 unit; dose 1 apheresis 5 whole equivalents. The outcomes mortality change Multiple Organ Dysfunction Score (ΔMODS) comparing preoperative score with highest composite through earliest death, discharge, day 7. Outcomes compared low ratios. Linear Cox regression explore relationships predictors continuous time event Results A 324 subjects met definition transfusion. In receiving plasma:RBC ratio, mean (SE) 7- 28-day ΔMODS 1.24 (0.45) 1.26 (0.56) points lower, (P = .007 P .024), respectively, than lower PLT:RBC 1.55 (0.53) 1.49 (0.65) .004 .022), respectively. Subjects received low-ratio excess 7-day (7.2% vs 1.7%, .0318), which remained significant at 28 days .035). PLT:RBCs not associated differences Conclusions This analysis found there an composition products Specifically, less organ dysfunction high-ratio transfusions (plasma:RBCs PLT:RBCs), transfusions.