![]() ![]() ![]() Findings: Neither the first measured ionized calcium concentration nor the dose of calcium administered was significantly associated with in-hospital mortality.Question: During hemostatic resuscitation for severe injury is the first measured ionized calcium or the dose of calcium administered as a molar proportion of the citrate given in blood products significantly associated with in-hospital mortality?.Clinically, hypocalcemia during early hemostatic resuscitation after severe injury is important, but specific treatment protocols must await better understanding of calcium physiology in acute injury. In our study, though most patients had hypocalcemia during the 1 st3h of trauma center care, neither first nor administered calcium dose corrected for citrate load were significantly associated with in-patient mortality. There was no relationship between mortality and first or calcium dose corrected for citrate load. Higher in-hospital mortality was significantly associated with older age, higher NISS, AIS head, and admission lactate, and lower admission SBP and pH. Crude risk factors for in-hospital death included age, injury severity score (ISS), new ISS (NISS), Abbreviated Injury Scale (AIS) head, admission systolic blood pressure (SBP), pH, and lactate all P <. In total, 288 (83.2%) had hypocalcemia at first determination 296 (85.6%) had hypocalcemia in the last determination in the 1 st3h and 177 (51.2%) received at least 1 calcium replacement dose during that time. RESULTS:Ī total of 11,474 trauma patients were admitted to the emergency department over the study period, of whom 346 (3% average age: 44 ± 18 years 75% men) met all study criteria. Univariate and multivariable logistic regression analyses for the binary outcome of in-hospital death were performed. Citrate load was calculated on a unit-by-unit basis and used to calculate an administered calcium/citrate molar ratio. Demographic, injury severity, admission shock and laboratory data, blood product use and timing, and in-hospital mortality were extracted from Trauma Registry and Transfusion Service databases and electronic medical records. They also (1) received blood products during transport or during the first 3 hours of in-hospital care (1 st3h) of trauma center care and (2) had at least one recorded in that time. We performed a retrospective cohort study of all admissions to our regional level 1 trauma center who (1) were ≥15 years old (2) presented from scene of injury (3) were admitted between October 2016 and September 2018 and (4) had a Massive Transfusion Protocol activation. We determined the frequency of hypocalcemia and quantified the association between the first measured ionized calcium concentration and calcium administration early during hemostatic resuscitation and in-hospital mortality. ![]() However, the dynamics of ionized calcium during hemostatic resuscitation of severe injury are not well studied. Transfusion of citrated blood products may worsen resuscitation-induced hypocalcemia and trauma outcomes, suggesting the need for protocolized early calcium replacement in major trauma. Hess, MD, MPH, FACP, FAAAS, Department of Laboratory Medicine and Pathology, Harborview Medical Center, University of Washington, 325 9th Ave, Seattle, WA 98104. Reprints will not be available from the authors.Īddress correspondence to John R. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website. Supplemental digital content is available for this article. The authors declare no conflicts of interest. §Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.Īccepted for publication December 31, 2020. ‡Department of Surgery, University of Washington, School of Medicine, Seattle, Washington †Department of Anesthesiology and Pain Medicine University of Washington, School of Medicine, Seattle, Washington From the *Harborview Injury Prevention and Research Center, Seattle, Washington ![]()
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