Platelet transfusion increases risk for acute respiratory distress syndrome in non-massively transfused blunt trauma patients
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.
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.
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)].
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.
KeywordsBlunt trauma Platelets Transfusion Glue Grant Acute lung injury/acute respiratory distress syndrome
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.
- 1.The Injury Center at the Centers for Disease Control and Prevention. Injury prevention & control—data & statistics (WISQARS). 2015. https://www.cdc.gov/injury/wisqars/leadingcauses.html. Accessed 23 Feb 2017.
- 2.The World Health Organization. The top 10 causes of death. 2014. https://www.who.int/mediacentre/factsheets/fs310/en/. Accessed 23 Feb 2017.
- 18.Kasotakis G, Sideris A, Yang Y, de Moya M, Alam H, King DR, et al. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database. J Trauma Acute Care Surg. 2013;74:1215–21 (discussion 21–2).PubMedPubMedCentralGoogle Scholar
- 19.Evans HL, Cuschieri J, Moore EE, Shapiro MB, Nathens AB, Johnson JL, et al. Inflammation and the host response to injury, a Large-Scale Collaborative Project: patient-oriented research core standard operating procedures for clinical care IX. Definitions for complications of clinical care of critically injured patients. J Trauma. 2009;67:384–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Kasotakis G, Galvan M, King E, Sarkar B, Stucchi A, Mizgerd JP, Burke PA, Remick D. Valproic acid mitigates the inflammatory response and prevents acute respiratory distress syndrome in a murine model of Escherichia coli pneumonia at the expense of bacterial clearance. J Trauma Acute Care Surg. 2017;82(4):758–65.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Zink KA, Sambasivan CN, Holcomb JB, Chisholm G, Schreiber MA. A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study. Am J Surg. 2009;197:565–70 (discussion 70).Google Scholar
- 38.Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471–82.CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. The role of the lung in postinjury multiple organ failure. Surgery. 2005;138:749–57 (discussion 57–8).Google Scholar
- 42.Bierling P, Bux J, Curtis B, Flesch B, Fung L, Lucas G, et al. ISBT Working Party on Granulocyte Immunobiology: Recommendations of the ISBT Working Party on Granulocyte Immunobiology for leucocyte antibody screening in the investigation and prevention of antibody-mediated transfusion-related acute lung injury. Vox Sanguinis. 2009;96:266–9.CrossRefPubMedGoogle Scholar