Platelet transfusion increases risk for acute respiratory distress syndrome in non-massively transfused blunt trauma patients

  • George Kasotakis
  • Nichole Starr
  • Erek Nelson
  • Bedabrata Sarkar
  • Peter Ashley Burke
  • Daniel George Remick
  • Ronald Gary Tompkins
  • The Inflammation and Host Response to Injury Investigators
Original Article

Abstract

Purpose

While damage control resuscitation is known to confer a survival advantage in severely injured patients, high-ratio blood component therapy should be initiated only in carefully selected trauma patients, due to the morbidity associated with blood product use. With this project, we aim to identify the effect of platelet transfusion in non-massively transfused bluntly injured patients.

Methods

The Glue Grant database was retrospectively queried and severely injured blunt trauma patients who underwent non-massive transfusion were identified. Patients were divided into quartiles depending on platelet volume they were transfused in the first 48 h. Outcomes of interest included mortality; ventilator, Intensive Care Unit (ICU) and hospital length of stay (LOS); infectious and non-infectious complications. Multivariable regression models were fitted for these outcomes, controlling for age, pre-existing comorbidities, injury severity, acute physiologic derangement, neurologic injury burden, and other fluid and blood product resuscitation.

Results

There was no difference in mortality, LOS, or the incidence of multi-organ failure and infectious complications. However, patients receiving ≥ 250 mL of platelets were more likely to develop acute respiratory distress syndrome (ARDS) compared to those who received < 250 mL [odds ratio 1.91 (95% CI 1.10–3.33, p = 0.022)].

Conclusions

Pre-emptive platelet transfusion should be avoided in non-massively transfused blunt injury victims in the absence of true or functional thrombocytopenia, as it increases risk for ARDS with no survival benefit.

Keywords

Blunt trauma Platelets Transfusion Glue Grant Acute lung injury/acute respiratory distress syndrome 

Notes

Author contributions

GK and NS were responsible for the study design, statistical analysis and manuscript drafting; EN for database maintenance and statistical analysis; BS, PB and RT for critical manuscript revision; and PB, DR and RT for providing overall oversight and critical manuscript revision; RT is the main PI for the Glue Grant project.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest, and all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • George Kasotakis
    • 1
  • Nichole Starr
    • 1
  • Erek Nelson
    • 1
  • Bedabrata Sarkar
    • 1
  • Peter Ashley Burke
    • 1
  • Daniel George Remick
    • 2
  • Ronald Gary Tompkins
    • 3
  • The Inflammation and Host Response to Injury Investigators
  1. 1.Division of Trauma, Acute Care Surgery and Surgical Critical CareBoston University School of MedicineBostonUSA
  2. 2.Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonUSA
  3. 3.Division of Surgery, Science and BioengineeringMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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