Barmparas G, et al. - In patients receiving massive transfusion, researchers described the utilization of vasopressors (VP) and examined the association of their use with mortality. In the era of massive transfusion protocols, common utilization of vasopressors was observed in exsanguinating trauma patients. Their use seemed associated with a higher mortality risk. Compared to patients who do not receive vasopressors, deaths in patients receiving vasopressors were more likely to occur later. They recommend further research to describe the role of these agents in the resuscitation of trauma patients.

Methods

• For this analysis, researchers selected trauma patients admitted from January 2011 to October 2016 receiving massive transfusion, defined as 3 units of pRBC within the first hour from admission. Collection of data was performed regarding demographics, admission vital signs and labs, use of VP, surgical interventions and outcomes. They utilized standard statistical tools.

Results

• 120 trauma patients met inclusion criteria over the 5-year study period; median age was 39 years, 77% were male and 41% were sustaining a penetrating injury.
• Patients who received VP [VP (+)] more frequently indicated a lower admission GCS (median 4.5 vs. 14.0, p < 0.01) and less frequently had a penetrating injury (31% vs. 54%, p = 0.02).
• As per findings, the overall mortality was 49% and significantly higher in the VP (+) cohort (60% vs. 34%, AHR: 9.9, adjusted p = 0.03).
• An increase in mortality in a stepwise fashion was observed with increasing number of VP utilized, starting at 34% for no VP, to 78% for 3 VP, and 100% for 5 or more.
• In the VP (-) group, the majority of deaths (88%) occurred within one day from admission.
• For the VP (+) group, 57% of deaths were encountered within one day, with the remaining 43% occurring at a later time.