PMID- 22277689
OWN - NLM
STAT- MEDLINE
DCOM- 20120501
LR  - 20121003
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 55
IP  - 3
DP  - 2012 Mar
TI  - Intraoperative blood product resuscitation and mortality in ruptured abdominal 
      aortic aneurysm.
PG  - 688-92
LID - 10.1016/j.jvs.2011.10.028 [doi]
AB  - OBJECTIVES: The resuscitation of patients with ruptured abdominal aortic 
      aneurysms (RAAAs) has not been well studied, and the potential benefit of 
      autotransfusion (AT) is unknown. The increased use of fresh-frozen plasma (FFP) 
      has been associated with decreased mortality rates in trauma patients and may 
      also improve RAAA survival. We explored the influence of intraoperative AT and 
      FFP resuscitation on mortality rates in massively transfused RAAA patients. 
      METHODS: A single-center review of RAAA patient records from April 1989 to 
      October 2009 was undertaken. Clinical data and outcomes were studied. Operative 
      and anesthesia records were queried for intraoperative transfusion totals. 
      Massive transfusion was defined as >/=10 units of red blood cells (RBCs) inclusive 
      of AT units. RESULTS: We identified 151 RAAA patients, of which 89 (60%) received 
      a massive transfusion and comprised the study population. These 89 patients had 
      an in-hospital mortality rate of 44%. Univariate predictors of mortality included 
      increased age, preoperative hypotension, operative blood loss, and crystalloid, 
      RBCs, and FFP volume. AT was used in 85 patients, with an increased ratio of 
      AT:RBC units associated with survival. Mortality was 34% with AT:packed RBCs 
      (PRBC) >/=1 (high AT) and 55% with AT:PRBC of <1 (low AT; P = .04). On multivariate 
      analysis, age > 74 years (P = .03), lowest preoperative systolic blood pressure 
      (SBP) <90 mm Hg (P = .06), blood loss >6 liters (P = .06), and low AT (P = .02) 
      independently predicted mortality. The mean RBC:FFP ratio was similar in those 
      that died (2.7) and in those that lived (2.9; P = .66). RBC:FFP </=2 (high FFP) was 
      present in 38 (43%) patients, with mortality of 49%. RBC:FFP >2 (low FFP) had 40% 
      mortality (P = .39). RBC:FFP ratios decreased over time from 3.6 (years 1989 to 
      1999) to 2.2 (years 2000 to 2009; P < .001), but more liberal use of FFP was not 
      associated with decreased mortality (47% vs 41%; P = .56). AT:PRBC ratios were 
      stable over time (range, 1.4-1.2; P = .18). CONCLUSIONS: Greater use of AT but 
      not of FFP was associated with survival in massively transfused RAAA patients. No 
      mortality benefit was seen with increased FFP, but few patients had high FFP 
      transfusion ratios. Further study to identify RAAA patients at risk for massive 
      transfusion should be undertaken and a potentially greater role for AT in RAAA 
      resuscitation investigated.
CI  - Published by Mosby, Inc.
FAU - Kauvar, David S
AU  - Kauvar DS
AD  - Vascular Surgery Service, San Antonio Military Medical Center, Fort Sam Houston, 
      TX 78234, USA. david.kauvar@us.army.mil
FAU - Sarfati, Mark R
AU  - Sarfati MR
FAU - Kraiss, Larry W
AU  - Kraiss LW
LA  - eng
PT  - Journal Article
DEP - 20120124
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Aneurysm, Abdominal/*mortality/*surgery
MH  - Aortic Rupture/*mortality/*surgery
MH  - Blood Loss, Surgical/*mortality
MH  - Blood Transfusion/*mortality
MH  - Blood Transfusion, Autologous/mortality
MH  - Chi-Square Distribution
MH  - Erythrocyte Transfusion/mortality
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Resuscitation/*mortality
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Utah/epidemiology
MH  - Vascular Surgical Procedures/*mortality
EDAT- 2012/01/27 06:00
MHDA- 2012/05/02 06:00
CRDT- 2012/01/27 06:00
PHST- 2011/09/13 00:00 [received]
PHST- 2011/10/10 00:00 [revised]
PHST- 2011/10/11 00:00 [accepted]
PHST- 2012/01/27 06:00 [entrez]
PHST- 2012/01/27 06:00 [pubmed]
PHST- 2012/05/02 06:00 [medline]
AID - S0741-5214(11)02378-0 [pii]
AID - 10.1016/j.jvs.2011.10.028 [doi]
PST - ppublish
SO  - J Vasc Surg. 2012 Mar;55(3):688-92. doi: 10.1016/j.jvs.2011.10.028. Epub 2012 Jan 
      24.