{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T06:02:04Z","timestamp":1782540124677,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5-6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Hemorrhage is the leading cause of potentially preventable death on the battlefield. Resuscitation with blood products is essential to restore circulating volume, repay the oxygen debt, and prevent coagulopathy. Massive transfusion (MT) occurs frequently after major trauma; a subset of casualties requires a supermassive transfusion (SMT), and thus, mobilization of additional resources remains unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry. In this analysis, we isolated U.S. and Coalition casualties that received at least 1 unit of packed red blood cells (PRBCs) or whole blood (WB). Given a lack of consensus on the definition of SMT recipients, we included those patients receiving the top quartile of PRBC and WB administered within the first 24\u2009hours following arrival to a military treatment facility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 25,897 adult casualties from January 1, 2007 to March 17, 2020. Within this dataset, 2,608 (9.0%) met inclusion for this analysis. The median number of total products administered within the first 24\u2009hours was 8 units of PRBC or WB. The upper quartile was 18 units (n\u2009=\u2009666). Compared to all other blood product recipients, patients in the SMT cohort had a higher median injury severity score (27 vs 18, P\u2009&amp;lt;\u20090.001), were most frequently injured by explosives (84.9% vs 68.6%, P\u2009&amp;lt;\u20090.001), had a higher mean emergency department (ED) pulse (128 vs 111, P\u2009&amp;lt;\u20090.001), a lower mean systolic blood pressure (122 vs 132\u2009mm Hg, P\u2009&amp;lt;\u20090.001), and a higher mean international normalized ratio (1.68 vs 1.38, P\u2009&amp;lt;\u20090.001). SMT patients experienced lower survival to hospital discharge (85.8% vs 93.3%, P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Compared to all other PRBC and WB recipients, SMT patients experienced more injury by explosives, severe injury patterns, ED vital sign derangements, and mortality. These findings may help identify those casualties who may require earlier aggressive resuscitation. However, more data is needed to define this population early in their clinical course for early identification to facilitate rapid resource mobilization. Identifying casualties who are likely to die within 24\u2009hours compared to those who are likely to survive, may assist in determining a threshold for a SMT.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab455","type":"journal-article","created":{"date-parts":[[2021,11,6]],"date-time":"2021-11-06T14:59:29Z","timestamp":1636210769000},"page":"e1022-e1027","source":"Crossref","is-referenced-by-count":11,"title":["A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1994-7774","authenticated-orcid":false,"given":"Andrew D","family":"Fisher","sequence":"first","affiliation":[{"name":"Medical Command, Texas Army National Guard , Austin, TX 78763, USA"},{"name":"Department of Surgery, University of New Mexico School of Medicine, 1 University of New Mexico , Albuquerque, NM 87131, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S","family":"Lavender","sequence":"additional","affiliation":[{"name":"Horace Greeley High School , Chappaqua, NY 10514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-441X","authenticated-orcid":false,"given":"Michael D","family":"April","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronnie","family":"Hill","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , San Antonio, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1450-5221","authenticated-orcid":false,"given":"James","family":"Bynum","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , San Antonio, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2322-5216","authenticated-orcid":false,"given":"Steven G","family":"Schauer","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , San Antonio, TX 78234, USA"},{"name":"Department of Emergency Medicine , Brooke Army Medical Center, JBSA Fort Sam Houston, TX, 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,6]]},"reference":[{"key":"2023051613492068300_R1","volume-title":"A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury","author":"National Academies of Sciences E, Medicine","year":"2016"},{"issue":"6, Suppl 5","key":"2023051613492068300_R2","doi-asserted-by":"crossref","first-page":"S431","DOI":"10.1097\/TA.0b013e3182755dcc","article-title":"Death on the battlefield (2001-2011): implications for the future of combat casualty care","volume":"73","author":"Eastridge","year":"2012","journal-title":"J Trauma"},{"issue":"6S Suppl 1","key":"2023051613492068300_R3","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1097\/TA.0000000000001436","article-title":"Hemorrhagic blood failure: oxygen debt, coagulopathy, and endothelial damage","volume":"82","author":"White","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"issue":"12","key":"2023051613492068300_R4","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.1016\/j.ajem.2020.07.041","article-title":"Massive transfusion protocol in adult trauma population","volume":"38","author":"Meneses","year":"2020","journal-title":"Am J Emerg Med"},{"key":"2023051613492068300_R5","volume-title":"ACS TQIP Massive Transfusion in Trauma Guidelines","author":"Cryer","year":"2014"},{"key":"2023051613492068300_R6","volume-title":"Standards for Blood Banks and Transfusion Services. 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