TY - JOUR
T1 - Cryoprecipitate use in the PROMMTT study
AU - Holcomb, John B.
AU - Fox, Erin E.
AU - Zhang, Xuan
AU - White, Nathan
AU - Wade, Charles E.
AU - Cotton, Bryan A.
AU - Del Junco, Deborah J.
AU - Bulger, Eileen M.
AU - Cohen, Mitchell J.
AU - Schreiber, Martin A.
AU - Myers, John G.
AU - Brasel, Karen J.
AU - Phelan, Herb A.
AU - Alarcon, Louis H.
AU - Muskat, Peter
AU - Rahbar, Mohammad H.
PY - 2013
Y1 - 2013
N2 - BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.
AB - BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.
KW - Bleeding
KW - Cryoprecipitate
KW - Fibrinogen
KW - Injury
KW - PROMMTT
UR - http://www.scopus.com/inward/record.url?scp=84880422187&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84880422187&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e31828fa3ed
DO - 10.1097/TA.0b013e31828fa3ed
M3 - Article
C2 - 23778509
AN - SCOPUS:84880422187
SN - 2163-0755
VL - 75
SP - S31-S39
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1 SUPPL1
ER -