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Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm.
Surgery. 2010 Nov; 148(5):955-62.S

Abstract

BACKGROUND

The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA).

METHODS

A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis.

RESULTS

One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004).

CONCLUSION

For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.

Authors+Show Affiliations

Division of Vascular Surgery, Stanford University, Stanford, CA, USA. mwmell@stanford.eduNo 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

20378142

Citation

Mell, Matthew W., et al. "Effect of Early Plasma Transfusion On Mortality in Patients With Ruptured Abdominal Aortic Aneurysm." Surgery, vol. 148, no. 5, 2010, pp. 955-62.
Mell MW, O'Neil AS, Callcut RA, et al. Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Surgery. 2010;148(5):955-62.
Mell, M. W., O'Neil, A. S., Callcut, R. A., Acher, C. W., Hoch, J. R., Tefera, G., & Turnipseed, W. D. (2010). Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Surgery, 148(5), 955-62. https://doi.org/10.1016/j.surg.2010.02.002
Mell MW, et al. Effect of Early Plasma Transfusion On Mortality in Patients With Ruptured Abdominal Aortic Aneurysm. Surgery. 2010;148(5):955-62. PubMed PMID: 20378142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. AU - Mell,Matthew W, AU - O'Neil,Amy S, AU - Callcut,Rachael A, AU - Acher,Charles W, AU - Hoch,John R, AU - Tefera,Girma, AU - Turnipseed,William D, Y1 - 2010/04/07/ PY - 2009/09/03/received PY - 2010/02/05/accepted PY - 2010/4/10/entrez PY - 2010/4/10/pubmed PY - 2010/11/10/medline SP - 955 EP - 62 JF - Surgery JO - Surgery VL - 148 IS - 5 N2 - BACKGROUND: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). METHODS: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis. RESULTS: One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004). CONCLUSION: For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/20378142/Effect_of_early_plasma_transfusion_on_mortality_in_patients_with_ruptured_abdominal_aortic_aneurysm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(10)00072-3 DB - PRIME DP - Unbound Medicine ER -