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Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation.
Injury. 2010 Jan; 41(1):35-9.I

Abstract

INTRODUCTION

Recent retrospective studies have found high fresh frozen plasma (FFP) to packed red blood cell (PRBC) ratios during trauma resuscitation to be associated with improved mortality. Whilst this association may be related to a mortality bias present in these studies, there has been an overall tendency towards a 1:1 FFP:PRBC ratio in massive transfusion guidelines worldwide. The aim of this study was to retrospectively review the administration of FFP in patients undergoing massive transfusion during trauma resuscitation, to add to the evidence base for massive transfusion guidelines.

MATERIALS AND METHODS

Multi-trauma patients who were administered blood transfusions of 5units or more of packed red blood cells (PRBCs) in the first 4h were included in this study. Mortality was the primary endpoint with length of hospital stay, ICU hours and mechanically ventilated hours secondary endpoints.

RESULTS

There were 331 patients included in this study with a median Injury Severity Score (ISS) of 36 (25-50) and a mortality of 29.9%. There was little change in the ratio of FFP:PRBC transfused per patient from 2005 to 2008. A low FFP:PRBC ratio in the first 4h of resuscitation, older age, low initial GCS and coagulopathy on presentation were significant independent factors associated with mortality. When deaths in the first 24h were excluded, the FFP:PRBC ratio had no association with mortality.

DISCUSSION

This study has shown increased initial survival in association with higher FFP:PRBC ratios during massive transfusion in a population with a high proportion of blunt injuries. The association is difficult to interpret because of an inherent survival bias. The optimal ratio of FFP:PRBC during massive transfusion may be different to 1:1 and further prospective research is required. There is now an increasing need for well designed randomised controlled trials to determine the best FFP:PRBC ratio for the resuscitation of blunt multi-trauma patients.

Authors+Show Affiliations

Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia. b.mitra@alfred.org.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19833331

Citation

Mitra, Biswadev, et al. "Fresh Frozen Plasma (FFP) Use During Massive Blood Transfusion in Trauma Resuscitation." Injury, vol. 41, no. 1, 2010, pp. 35-9.
Mitra B, Mori A, Cameron PA, et al. Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation. Injury. 2010;41(1):35-9.
Mitra, B., Mori, A., Cameron, P. A., Fitzgerald, M., Paul, E., & Street, A. (2010). Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation. Injury, 41(1), 35-9. https://doi.org/10.1016/j.injury.2009.09.029
Mitra B, et al. Fresh Frozen Plasma (FFP) Use During Massive Blood Transfusion in Trauma Resuscitation. Injury. 2010;41(1):35-9. PubMed PMID: 19833331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation. AU - Mitra,Biswadev, AU - Mori,Alfredo, AU - Cameron,Peter A, AU - Fitzgerald,Mark, AU - Paul,Eldho, AU - Street,Alison, PY - 2009/06/06/received PY - 2009/09/12/revised PY - 2009/09/21/accepted PY - 2009/10/17/entrez PY - 2009/10/17/pubmed PY - 2010/9/3/medline SP - 35 EP - 9 JF - Injury JO - Injury VL - 41 IS - 1 N2 - INTRODUCTION: Recent retrospective studies have found high fresh frozen plasma (FFP) to packed red blood cell (PRBC) ratios during trauma resuscitation to be associated with improved mortality. Whilst this association may be related to a mortality bias present in these studies, there has been an overall tendency towards a 1:1 FFP:PRBC ratio in massive transfusion guidelines worldwide. The aim of this study was to retrospectively review the administration of FFP in patients undergoing massive transfusion during trauma resuscitation, to add to the evidence base for massive transfusion guidelines. MATERIALS AND METHODS: Multi-trauma patients who were administered blood transfusions of 5units or more of packed red blood cells (PRBCs) in the first 4h were included in this study. Mortality was the primary endpoint with length of hospital stay, ICU hours and mechanically ventilated hours secondary endpoints. RESULTS: There were 331 patients included in this study with a median Injury Severity Score (ISS) of 36 (25-50) and a mortality of 29.9%. There was little change in the ratio of FFP:PRBC transfused per patient from 2005 to 2008. A low FFP:PRBC ratio in the first 4h of resuscitation, older age, low initial GCS and coagulopathy on presentation were significant independent factors associated with mortality. When deaths in the first 24h were excluded, the FFP:PRBC ratio had no association with mortality. DISCUSSION: This study has shown increased initial survival in association with higher FFP:PRBC ratios during massive transfusion in a population with a high proportion of blunt injuries. The association is difficult to interpret because of an inherent survival bias. The optimal ratio of FFP:PRBC during massive transfusion may be different to 1:1 and further prospective research is required. There is now an increasing need for well designed randomised controlled trials to determine the best FFP:PRBC ratio for the resuscitation of blunt multi-trauma patients. SN - 1879-0267 UR - https://www.unboundmedicine.com/medline/citation/19833331/Fresh_frozen_plasma__FFP__use_during_massive_blood_transfusion_in_trauma_resuscitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(09)00511-7 DB - PRIME DP - Unbound Medicine ER -