Abstract
Extremity vascular injuries (EVI) are rare, life-threatening injuries that may require ultra-massive transfusion (UMT), defined as transfusion of ≥20 units of red cell products in 24 hours. This study aimed to evaluate outcomes of patients with EVI who required UMT and to determine which variables are associated with survival.
A retrospective, multicenter analysis from eleven high-volume trauma centers was conducted of trauma patients who received UMT from 2016-2024. Demographic, clinical, and outcome data were obtained and compared between patients with/without an EVI with subgroup analysis based on mortality.
1,155 patients received UMT and 194 (16.8%) had an EVI. The majority (62.4%) of these injuries were penetrating, and those with an EVI had a lower Injury Severity Score (ISS) (30 vs. 34, p<0.01), underwent fewer resuscitative thoracotomies (19.1 vs. 24.9%, p=0.02), and fewer exploratory laparotomies (61.3 vs. 82.7%, p<0.01). Of all EVI patients, 79 patients (40.7%) had an isolated EVI. More than half of patients with an EVI survived compared to only a third without an EVI (50.5 vs. 33.3%, p<0.01). There was no difference in the transfusion of blood products. Among EVI patients, survivors had a lower ISS (27 vs. 33, p<0.01), higher initial heart rate (111 vs. 87 beats per minute, p<0.01), higher Glasgow Coma Scale score (10 vs. 7, p<0.01), higher initial platelet count (169 vs. 140 103/mcL, p = 0.02), lower lactate (8.2 vs. 12.5 mmol/L, p<0.01), and smaller base deficit (11.5 vs. 16.1 mmol/L, p<0.01).
In patients who require UMT, EVI is associated with a higher rate of survival compared to those without EVI.