The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis.
Bui E, Inaba K, Ebadat A, Karamanos E, Byerly S, Okoye O, Shulman I, Rhee P, Demetriades D. The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis. Eur J Trauma Emerg Surg. 2016 Aug;42(4):519-525.
Eur J Trauma Emerg Surg
PURPOSE: Transfusion ratios approaching 1:1 FFP:PRBC for trauma resuscitation have become the de facto standard of care. The aim of this study was to prospectively evaluate the effect of increasing ratios of FFP:PRBC transfusion on survival for massively transfused civilian trauma patients as well as determine if time to reach the target ratio had any effect on outcomes.
METHODS: This is a prospective, observational study of all trauma patients requiring a massive transfusion (≥10 PRBC in ≤24 h) at a level 1 trauma center over a 2.5-year period. The ratio of FFP:PRBC was tracked hourly up to 24 h post-initiation of massive transfusion. A logistic regression model was utilized to identify the ideal ratio associated with mortality prediction. A stepwise logistic regression was performed to identify independent predictors of mortality.
RESULTS: The study population was predominantly male (89 %) with a mean age of 34.8 ± 16. On admission, 22 % had a systolic blood pressure ≤90 mmHg, 47 % had a heart rate ≥120, and 25 % had a GCS ≤8. The overall mortality was 33 %. The ratio of FFP:PRBC ≥ 1:1.5 was the second most important independent predictor of mortality for this population (R (2) = 0.59). Survivors had a higher FFP:PRBC ratio at all times during the first 24 h of resuscitation.
CONCLUSIONS: Achieving a ratio of FFP:PRBC ≥ 1:1.5 after the initial 24 h of resuscitation significantly improves survival in massively transfused trauma patients compared to patients that achieved a ratio <1:1.5.
Medical Subject Headings
Adult; Critical Care; Erythrocyte Transfusion; Female; Hospital Mortality; Humans; Length of Stay; Logistic Models; Los Angeles; Male; Multiple Trauma; Prospective Studies; Resuscitation; Survival Analysis; Trauma Centers; Treatment Outcome