InSpectra St0

Hutchinson Technologies

Question: What is the utility of InSpectra™ StO2 in Massive Blood Transfusion trauma patients?

Summary Response: “Patients who require massive blood transfusion can be predicted early, and persistent low StO2 identifies those patients destined to have poor outcome.”1

Background:

  • Early post-injury massive blood transfusion requires a delicate balance between recognizing the patient who will require Massive Transfusion (MT) and managing the interventions to not promote bleeding, worsening inflammatory and coagulopathic responses. A ‘damage control’ resuscitation strategy may be needed in these patients, rather than traditional Advanced Trauma Life Support (ATLS).1
  • Damage control resuscitation strategies under discussion include: reducing the amount of isotonic crystalloid administered; changing ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) to 1:1; discouraging aggressive control of blood pressure until bleeding is controlled; and considering early use of Factor VIIa.1
  • Massive Transfusion (defined as 10 units of PRBC in the first 24 hours) is uncommon, only 1-2% of trauma patients at major U.S. trauma centers.1 Most MT patients are identified in the first hour of TC arrival and two-thirds of those who will exsanguinate do so in the first six hours. The clinician must make early critical decisions to start aggressive FFP, administer Factor VIIa, and/or take the patient to the OR for damage control surgery.

InSpectra™ StO2 Trauma Study: additional analysis for Massive Transfusion

  • The InSpectra StO2 Trauma Study was a multicenter, prospective, observational, nonrandomized cohort study at seven Level I trauma centers in the U.S., which enrolled 383 severely injured trauma patients immediately upon trauma center arrival. (See Cohn et al. J Trauma. 2007;62:44-55 for complete study protocol and results.) This study database was queried for massive transfusion patients who received ³ 3000ml (10 units) of packed red blood cells in the first 24 hours after trauma center admission.
  • One hundred fourteen patients (30%) required massive transfusion. MT patients received substantially more PRBC, fresh frozen plasma and crystalloid/colloid infusions than non-MT patients.
  • MT patients had significantly more ICU and ventilator days, higher MODS (31%) and mortality (33%) than non-MT patients.
  • Minimum InSpectra StO2 assessed in the first three hours in MT patients was the only consistent independent predictor of MODS or death. Minimum systolic blood pressure, maximum base deficit, minimum hemoglobin, maximum INR and minimum platelet count were not consistent predictors in the first three hours.
  • StudyingInSpectra StO2 may be important to identify the need for novel damage control resuscitation techniques such as aggressive FFP infusions, administering Factor VIIa, OR triage for novel damage control, etc. to be administered early to the appropriate high risk patient—the earlier the recognition and intervention, the more likely a demonstrable favorable impact on early survival.


References

  1. Moore FA, Nelson T, McKinley BA et al. Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. J Trauma. 2008;64:1-14.