NDLI: An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sperry, Jason L. Ochoa, Juan B. Gunn, Scott R. Alarcon, Louis H. Minei, Joseph P. Cuschieri, Joseph Rosengart, Matthew R. Maier, Ronald V. Billiar, Timothy R. Peitzman, Andrew B. Moore, Ernest E.
Description	Country affiliation: United States Author Affiliation: Sperry JL ( Division of General Surgery and Trauma, Departments of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. sperryjl@upmc.edu)
Abstract	OBJECTIVE: The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required >/=8 units PRBCs within the first 12 hours postinjury were analyzed (n = 415). RESULTS: Patients who received transfusion products in >/=1:1.50 FFP:PRBC ratio (high F:P ratio, n = 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n = 313) required significantly less blood transfusion at 24 hours (16 +/- 9 units vs. 22 +/- 17 units, p = 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p = 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p = 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p = 0.002, 95% CI 0.3-0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders. CONCLUSIONS: In patients requiring >/=8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio >/=1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.
File Format	HTM / HTML
ISSN	00225282
Issue Number	5
Volume Number	65
e-ISSN	15298809
Journal	The Journal of Trauma: Injury, Infection, and Critical Care
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-11-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Research Support, N.i.h., Extramural Therapy Plasma Prospective Studies Clinical Trial Erythrocyte Transfusion Mortality Humans Middle Aged Male Discipline Traumatology Journal Article Shock, Hemorrhagic Wounds, Nonpenetrating Blood Component Transfusion Etiology Adult Female Multicenter Study Methods
Content Type	Text
Resource Type	Article
Subject	Surgery Critical Care and Intensive Care Medicine

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