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[JAMA Surg发表论文]:接受大量输血的严重创伤患儿使用冷沉淀与生存率的相关性
2021年07月17日 时讯速递, 进展交流 暂无评论

Original Investigation February 17, 2021

Association of Cryoprecipitate Use With Survival After Major Trauma in Children Receiving Massive Transfusion

Maria A. Tama, Melvin E. Stone Jr, Stephen M. Blumberg, et al

JAMA Surg. 2021;156(5):453-460. doi:10.1001/jamasurg.2020.7199

Abstract

Importance

Although most massive transfusion protocols incorporate cryoprecipitate in the treatment of hemorrhaging injured patients, minimal data exist on its use in children, and whether its addition improves their survival is unclear.

Objective

To determine whether cryoprecipitate use for injured children who receive massive transfusion is associated with lower mortality.

Design, Setting, and Participants

This retrospective cohort study included injured patients examined between January 1, 2014, and December 31, 2017, at one of multiple centers across the US and Canada participating in the Pediatric Trauma Quality Improvement Program. Patients were aged 18 years or younger and had received massive transfusion, which was defined as at least 40 mL/kg of total blood products in the first 4 hours after emergency department arrival. Exclusion criteria included hospital transfer, arrival without signs of life, time of death or hospital discharge not recorded, and isolated head injuries. To adjust for potential confounding, a propensity score for treatment was created and inverse probability weighting was applied. The propensity score accounted for age, sex, race/ethnicity, injury type, payment type, Glasgow Coma Scale score, hypoxia, hypotension, assisted respirations, chest tube status, Injury Severity Score, total volume of blood products received, hemorrhage control procedure, hospital size, academic status, and trauma center designation. Data were analyzed from December 11, 2019, to August 31, 2020.

Exposures

Cryoprecipitate use within the first 4 hours of emergency department arrival.

Main Outcomes and Measures

In-hospital 24-hour and 7-day mortality.

Results

Of the 2387 injured patients who received massive transfusion, 1948 patients were eligible for analysis. The median age was 16 years (interquartile range, 9-17 years), 1382 patients (70.9%) were male, and 807 (41.4%) were White. A total of 541 patients (27.8%) received cryoprecipitate. After propensity score weighting, patients who received cryoprecipitate had a significantly lower 24-hour mortality when compared with those who did not (adjusted difference, −6.9%; 95% CI, −10.6% to −3.2%). Moreover, cryoprecipitate use was associated with a significantly lower 7-day mortality but only in children with penetrating trauma (adjusted difference, −9.2%; 95% CI, −15.4% to −3.0%) and those transfused at least 100 mL/kg of total blood products (adjusted difference, −7.7%; 95% CI, −15.0% to −0.5%).

Conclusions and Relevance

In this cohort study, early use of cryoprecipitate was associated with lower 24-hour mortality among injured children who required massive transfusion. The benefit of cryoprecipitate appeared to persist for 7 days only in those with penetrating trauma and in those who received extremely large-volume transfusion.

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