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. 2024 Feb:228:192-198.
doi: 10.1016/j.amjsurg.2023.09.024. Epub 2023 Sep 25.

Defining Ultra-Massive Transfusion through a Systematic Review

Courtney H Meyer  1   2   3 , Neal Mody Bailey  4 , Sharon L Leslie  5 , Kenya Thrasher  1   6 , Zach Grady  1   2 , M Sanders  7 , Erica Moore  7 , K W Nicely  7 , Randi N Smith  1   2   3
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Defining Ultra-Massive Transfusion through a Systematic Review

Courtney H Meyer et al. Am J Surg. 2024 Feb.

Abstract

Background: Despite the widespread use of ultra-massive transfusion (UMT) as an intervention for trauma patients in hemorrhagic shock, no standard definition exists. We performed a systematic review to determine a consensus definition for UMT.

Methods: A search was performed from 1979-2022. The authors screened studies defining UMT and associated outcomes as defined by our prespecified PICO questions. The PRISMA guidelines were used.

Results: 1662 articles met criteria for eligibility assessment, 17 for full-text review and eight for data extraction. Only two studies demonstrated a consensus definition of UMT, which used ≥20 units of red blood cell product within 24hrs. Parameters associated with increased mortality included lower blood pressure, lower pulse and lower Glasgow Coma Score at the time of presentation and a higher injury severity score and undergoing a resuscitative thoracotomy.

Conclusions: The absence of a consensus definition for UMT raises challenges from clinical, research and ethical perspectives. Based on our findings, the authors advocate for the feasibility of standardizing the definition of UMT as ≥20 units of red blood cell product within 24hrs.

Keywords: Blood transfusion; consensus definition; systematic review; trauma patient; ultra-massive.

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Conflict of interest statement

Conflict of Interest Statement: The authors have no conflicts of interest to disclose

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