Abstract
Background
Massive transfusion protocol (MTP) is increasingly used in civilian trauma resuscitation.
Calcium is vital for coagulation, but hypocalcemia commonly occurs during massive
transfusion due to citrate and serum calcium chelation. This study was conducted to
determine the incidence of hypocalcemia and severe hypocalcemia in trauma patients
who receive massive transfusion and to compare characteristics of patients with severe
versus nonsevere hypocalcemia.
Materials and methods
This was a retrospective study of trauma patients who received massive transfusion
between January 2009 and November 2013. The primary outcome was the incidence of hypocalcemia
(ionized calcium [iCa] < 1.12 mmol/L) and severe hypocalcemia (iCa < 0.90 mmol/L).
Secondary outcomes included calcium monitoring, calcium replacement, and correction
of coagulopathy.
Results
There were 156 patients included; 152 (97%) experienced hypocalcemia, and 111 (71%)
had severe hypocalcemia. Patients were stratified into iCa ≥ 0.90 (n = 45) and iCa < 0.90 (n = 111). There were no differences in demographics or baseline laboratories except
the severe hypocalcemia group had higher baseline activated partial thromboplastin
time (29.7 [23.7–50.9] versus 25.8 [22.3–35.9], P = 0.003), higher lactic acid (5.8 [4.1–9.8] versus 4.0 [3.1–7.8], P = 0.019), lower platelets (176 [108–237] versus 208 [169–272], P = 0.003), and lower pH (7.14 [6.98–7.28] versus 7.23 [7.14–7.33], P = 0.019). Mortality was higher in the severe hypocalcemia group (49% versus 24%, P = 0.007). Patients in the iCa < 0.90 group received more blood products (34 [23–58]
versus 22 [18–30] units, P < 0.001), and calcium chloride (4 [2–7] versus 3 [1–4] g, P = 0.002), but there was no difference in duration of MTP or final iCa. Neither group
reached a median iCa > 1.12.
Conclusions
Hypocalcemia is common during MTP, and vigilant monitoring is warranted. Research
is needed to effectively manage hypocalcemia during massive transfusion.
Keywords
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Article info
Publication history
Published online: December 30, 2015
Accepted:
December 22,
2015
Received in revised form:
November 11,
2015
Received:
September 10,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
