Cryoprecipitate use in the PROMMTT study

John B. Holcomb, Erin E. Fox, Xuan Zhang, Nathan White, Charles E. Wade, Bryan A. Cotton, Deborah J. Del Junco, Eileen M. Bulger, Mitchell J. Cohen, Martin Schreiber, John G. Myers, Karen Brasel, Herb A. Phelan, Louis H. Alarcon, Peter Muskat, Mohammad H. Rahbar

    Research output: Contribution to journalArticle

    31 Citations (Scopus)

    Abstract

    BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    Volume75
    Issue number1 SUPPL1
    DOIs
    StatePublished - 2013

    Fingerprint

    Fibrinogen
    Injury Severity Score
    Wounds and Injuries
    Hospital Mortality
    Hospital Emergency Service
    Hemoglobins
    Blood Pressure
    Glasgow Coma Scale
    International Normalized Ratio
    Survival
    Partial Thromboplastin Time
    Trauma Centers
    Prothrombin Time
    Proportional Hazards Models
    Abdomen
    Thorax
    Logistic Models

    Keywords

    • Bleeding
    • Cryoprecipitate
    • Fibrinogen
    • Injury
    • PROMMTT

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Holcomb, J. B., Fox, E. E., Zhang, X., White, N., Wade, C. E., Cotton, B. A., ... Rahbar, M. H. (2013). Cryoprecipitate use in the PROMMTT study. Journal of Trauma and Acute Care Surgery, 75(1 SUPPL1). https://doi.org/10.1097/TA.0b013e31828fa3ed

    Cryoprecipitate use in the PROMMTT study. / Holcomb, John B.; Fox, Erin E.; Zhang, Xuan; White, Nathan; Wade, Charles E.; Cotton, Bryan A.; Del Junco, Deborah J.; Bulger, Eileen M.; Cohen, Mitchell J.; Schreiber, Martin; Myers, John G.; Brasel, Karen; Phelan, Herb A.; Alarcon, Louis H.; Muskat, Peter; Rahbar, Mohammad H.

    In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1 SUPPL1, 2013.

    Research output: Contribution to journalArticle

    Holcomb, JB, Fox, EE, Zhang, X, White, N, Wade, CE, Cotton, BA, Del Junco, DJ, Bulger, EM, Cohen, MJ, Schreiber, M, Myers, JG, Brasel, K, Phelan, HA, Alarcon, LH, Muskat, P & Rahbar, MH 2013, 'Cryoprecipitate use in the PROMMTT study', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e31828fa3ed
    Holcomb JB, Fox EE, Zhang X, White N, Wade CE, Cotton BA et al. Cryoprecipitate use in the PROMMTT study. Journal of Trauma and Acute Care Surgery. 2013;75(1 SUPPL1). https://doi.org/10.1097/TA.0b013e31828fa3ed
    Holcomb, John B. ; Fox, Erin E. ; Zhang, Xuan ; White, Nathan ; Wade, Charles E. ; Cotton, Bryan A. ; Del Junco, Deborah J. ; Bulger, Eileen M. ; Cohen, Mitchell J. ; Schreiber, Martin ; Myers, John G. ; Brasel, Karen ; Phelan, Herb A. ; Alarcon, Louis H. ; Muskat, Peter ; Rahbar, Mohammad H. / Cryoprecipitate use in the PROMMTT study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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    abstract = "BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29{\%}) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7{\%}to 82{\%}.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72{\%} received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.",
    keywords = "Bleeding, Cryoprecipitate, Fibrinogen, Injury, PROMMTT",
    author = "Holcomb, {John B.} and Fox, {Erin E.} and Xuan Zhang and Nathan White and Wade, {Charles E.} and Cotton, {Bryan A.} and {Del Junco}, {Deborah J.} and Bulger, {Eileen M.} and Cohen, {Mitchell J.} and Martin Schreiber and Myers, {John G.} and Karen Brasel and Phelan, {Herb A.} and Alarcon, {Louis H.} and Peter Muskat and Rahbar, {Mohammad H.}",
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    T1 - Cryoprecipitate use in the PROMMTT study

    AU - Holcomb, John B.

    AU - Fox, Erin E.

    AU - Zhang, Xuan

    AU - White, Nathan

    AU - Wade, Charles E.

    AU - Cotton, Bryan A.

    AU - Del Junco, Deborah J.

    AU - Bulger, Eileen M.

    AU - Cohen, Mitchell J.

    AU - Schreiber, Martin

    AU - Myers, John G.

    AU - Brasel, Karen

    AU - Phelan, Herb A.

    AU - Alarcon, Louis H.

    AU - Muskat, Peter

    AU - Rahbar, Mohammad H.

    PY - 2013

    Y1 - 2013

    N2 - BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

    AB - BACKGROUND: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival. METHODS: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death. RESULTS: Cryoprecipitate use varied significantly by center, ranging from7%to 82%.Among patientswho received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10Y20). The median time fromadmission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center. CONCLUSION: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients.We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

    KW - Bleeding

    KW - Cryoprecipitate

    KW - Fibrinogen

    KW - Injury

    KW - PROMMTT

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