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Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years?
J Trauma. 2008 Aug; 65(2):272-6; discussion 276-8.JT

Abstract

BACKGROUND

Recent military experience reported casualties who receive > 10 units of packed red blood cells (PRBC) in 24 hours have 20% versus 65% mortality when the fresh-frozen plasma (FFP) to PRBC ratio was 1:1 versus 1:4, respectively. We hypothesize a similar improvement in mortality in civilian trauma patients that require massive transfusion and are treated with a FFP to PRBC ratio closer to 1:1.

METHODS

Four-year retrospective study of all trauma patients who underwent emergency surgery in an urban Level I Trauma Center. Patients were divided into two groups; those that received < or = 10 units or > 10 units of PRBC during and after initial surgical intervention. Only patients who received transfusion of both FFP and PRBC were included in the analysis. The primary research question was the impact of initial FFP:PRBC ratio on mortality. Other variables for analysis included patient age, gender, mechanism, and Injury Severity Scale score. Both univariate and multivariate analysis were used to assess the relationship between outcome and predictors.

RESULTS

A total of 2,746 patients underwent surgical intervention of which 1,985 (72.2%) received no transfusion. Of those that received transfusion, 626 (22.8%) received < or = 10 units of PRBC and 135 (4.9%) > 10 units of PRBC. Out of the 626 patients that received < or = 10 units of PRBC, 250 (39.9%) received FFP and 376 (60.1%) received no FFP. All the patients that received > 10 units PRBC received FFP. In univariate analysis, a significant difference in mortality was found in patients who received > 10 units of PRBC (26% vs. 87.5%) when FFP:PRBC ratio was 1:1 versus 1:4 (p = 0.0001). Multivariate analysis in the group of patients that received > 10 units of PRBC showed a FFP:PRBC ratio of 1:4 was consistent with increased risk of mortality (relative risk, 18.88; 95% CI, 6.32-56.36; p = 0.001), when compared with a ratio of 1:1. Patients who received < or = 10 units of PRBC had a trend toward increased mortality (21.2% vs.11.8%) when the FFP:PRBC ratio was 1:4 versus 1:1 (p: 0.06).

CONCLUSION

An FFP to PRBC ratio close to 1:1 confers a survival advantage in patients requiring massive transfusion.

Authors+Show Affiliations

Division of Trauma/Critical Care Surgery, Department of Surgery, Tulane University School of Medicine New Orleans, Louisiana 70112-2699, USA. jduchesn@tulane.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18695461

Citation

Duchesne, Juan C., et al. "Review of Current Blood Transfusions Strategies in a Mature Level I Trauma Center: Were We Wrong for the Last 60 Years?" The Journal of Trauma, vol. 65, no. 2, 2008, pp. 272-6; discussion 276-8.
Duchesne JC, Hunt JP, Wahl G, et al. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J Trauma. 2008;65(2):272-6; discussion 276-8.
Duchesne, J. C., Hunt, J. P., Wahl, G., Marr, A. B., Wang, Y. Z., Weintraub, S. E., Wright, M. J., & McSwain, N. E. (2008). Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? The Journal of Trauma, 65(2), 272-6; discussion 276-8. https://doi.org/10.1097/TA.0b013e31817e5166
Duchesne JC, et al. Review of Current Blood Transfusions Strategies in a Mature Level I Trauma Center: Were We Wrong for the Last 60 Years. J Trauma. 2008;65(2):272-6; discussion 276-8. PubMed PMID: 18695461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? AU - Duchesne,Juan C, AU - Hunt,John P, AU - Wahl,Georgia, AU - Marr,Alan B, AU - Wang,Yi-Zarn, AU - Weintraub,Sharon E, AU - Wright,Mary J O, AU - McSwain,Norman E,Jr PY - 2008/8/13/pubmed PY - 2008/9/17/medline PY - 2008/8/13/entrez SP - 272-6; discussion 276-8 JF - The Journal of trauma JO - J Trauma VL - 65 IS - 2 N2 - BACKGROUND: Recent military experience reported casualties who receive > 10 units of packed red blood cells (PRBC) in 24 hours have 20% versus 65% mortality when the fresh-frozen plasma (FFP) to PRBC ratio was 1:1 versus 1:4, respectively. We hypothesize a similar improvement in mortality in civilian trauma patients that require massive transfusion and are treated with a FFP to PRBC ratio closer to 1:1. METHODS: Four-year retrospective study of all trauma patients who underwent emergency surgery in an urban Level I Trauma Center. Patients were divided into two groups; those that received < or = 10 units or > 10 units of PRBC during and after initial surgical intervention. Only patients who received transfusion of both FFP and PRBC were included in the analysis. The primary research question was the impact of initial FFP:PRBC ratio on mortality. Other variables for analysis included patient age, gender, mechanism, and Injury Severity Scale score. Both univariate and multivariate analysis were used to assess the relationship between outcome and predictors. RESULTS: A total of 2,746 patients underwent surgical intervention of which 1,985 (72.2%) received no transfusion. Of those that received transfusion, 626 (22.8%) received < or = 10 units of PRBC and 135 (4.9%) > 10 units of PRBC. Out of the 626 patients that received < or = 10 units of PRBC, 250 (39.9%) received FFP and 376 (60.1%) received no FFP. All the patients that received > 10 units PRBC received FFP. In univariate analysis, a significant difference in mortality was found in patients who received > 10 units of PRBC (26% vs. 87.5%) when FFP:PRBC ratio was 1:1 versus 1:4 (p = 0.0001). Multivariate analysis in the group of patients that received > 10 units of PRBC showed a FFP:PRBC ratio of 1:4 was consistent with increased risk of mortality (relative risk, 18.88; 95% CI, 6.32-56.36; p = 0.001), when compared with a ratio of 1:1. Patients who received < or = 10 units of PRBC had a trend toward increased mortality (21.2% vs.11.8%) when the FFP:PRBC ratio was 1:4 versus 1:1 (p: 0.06). CONCLUSION: An FFP to PRBC ratio close to 1:1 confers a survival advantage in patients requiring massive transfusion. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/18695461/Review_of_current_blood_transfusions_strategies_in_a_mature_level_I_trauma_center:_were_we_wrong_for_the_last_60_years L2 - https://doi.org/10.1097/TA.0b013e31817e5166 DB - PRIME DP - Unbound Medicine ER -