A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq

ABSTRACT Introduction Hemorrhage is the leading cause of potentially preventable death on the battlefield. Resuscitation with blood products is essential to restore circulating volume, repay the oxygen debt, and prevent coagulopathy. Massive transfusion (MT) occurs frequently after major trauma; a s...

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Bibliographic Details
Published in:Military medicine 2023-05, Vol.188 (5-6), p.e1022-e1027
Main Authors: Fisher, Andrew D, Lavender, Jason S, April, Michael D, Hill, Ronnie, Bynum, James, Schauer, Steven G
Format: Article
Language:English
Subjects:
Adult
Afghanistan
Blood Transfusion
Casualties
Explosive Agents
Explosives
Hemorrhage - therapy
Humans
Hypotension
Iraq
Retrospective Studies
Trauma
Wounds and Injuries - epidemiology
Wounds and Injuries - therapy
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Summary:ABSTRACT Introduction Hemorrhage is the leading cause of potentially preventable death on the battlefield. Resuscitation with blood products is essential to restore circulating volume, repay the oxygen debt, and prevent coagulopathy. Massive transfusion (MT) occurs frequently after major trauma; a subset of casualties requires a supermassive transfusion (SMT), and thus, mobilization of additional resources remains unclear. Materials and Methods This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry. In this analysis, we isolated U.S. and Coalition casualties that received at least 1 unit of packed red blood cells (PRBCs) or whole blood (WB). Given a lack of consensus on the definition of SMT recipients, we included those patients receiving the top quartile of PRBC and WB administered within the first 24 hours following arrival to a military treatment facility. Results We identified 25,897 adult casualties from January 1, 2007 to March 17, 2020. Within this dataset, 2,608 (9.0%) met inclusion for this analysis. The median number of total products administered within the first 24 hours was 8 units of PRBC or WB. The upper quartile was 18 units (n = 666). Compared to all other blood product recipients, patients in the SMT cohort had a higher median injury severity score (27 vs 18, P 
ISSN:0026-4075
1930-613X
DOI:10.1093/milmed/usab455