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Published in: European Journal of Trauma and Emergency Surgery 4/2016

01-08-2016 | Original Article

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

Authors: E. Bui, K. Inaba, A. Ebadat, E. Karamanos, S. Byerly, O. Okoye, I. Shulman, P. Rhee, D. Demetriades

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2016

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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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Metadata
Title
The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis
Authors
E. Bui
K. Inaba
A. Ebadat
E. Karamanos
S. Byerly
O. Okoye
I. Shulman
P. Rhee
D. Demetriades
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0573-1

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