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The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA

    E. Bui, K. Inaba, A. Ebadat, S. Byerly, O. Okoye, I. Shulman & D. Demetriades

  2. Division of Trauma, Critical Care, and Acute Care Surgery, University of Arizona, Tucson, AZ, USA

    P. Rhee

  3. Henry Ford Hospital, Wayne State University, Detroit, MI, USA

    E. Karamanos

Authors
  1. E. Bui
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  2. K. Inaba
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  3. A. Ebadat
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  4. E. Karamanos
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  5. S. Byerly
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  6. O. Okoye
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  7. I. Shulman
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  8. P. Rhee
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  9. D. Demetriades
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Corresponding author

Correspondence to K. Inaba.

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Conflict of interest

Eric Bui, Kenji Inaba, Aileen Ebadat, Efstathios Karamanos, Saskya Byerly, Obi Okoye, Ira Schulman, Peter Rhee, and Demetrios Demetriades declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bui, E., Inaba, K., Ebadat, A. et al. The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis. Eur J Trauma Emerg Surg 42, 519–525 (2016). https://doi.org/10.1007/s00068-015-0573-1

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  • DOI: https://doi.org/10.1007/s00068-015-0573-1

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