The North Pacific Surgical AssociationA high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study
Section snippets
Methods
A multicenter, retrospective analysis was performed at 16 level 1 trauma centers in the United States.10 The protocol was approved by the institutional review boards at all participating centers. Data were collected from trauma patients injured between July 2005 and June 2006 who received any PRBCs within 24 hours of admission. Patients who were transferred from other hospitals, prisoners, children less than age 16, pregnant patients, burn-injured patients, patients who had greater than or
Results
Data were obtained from 1,489 patients who received at least 1 U of PRBCs, including 466 massive transfusion patients. There were 14 patients for whom complete data was not available and they were excluded from analysis.
Demographics
The number of massively transfused patients receiving the various ratios of FFP and PLTs and their demographics are shown in Table 1, Table 2. Most patients received FFP:PRBCs in a ratio between 1:4 and 1:1 and PLTs:PRBCs in a ratio of <1:4. All groups had similar ISS, GCS, mechanism of injury, gender and age (Table 1, Table 2). The initial systolic blood pressure (SBP) and initial laboratory tests were similar among all groups, with the exception that those who received a ≥1:1 ratio of
Outcomes
The overall mortality was 41%. Mortality decreased significantly when patients received higher early ratios of FFP:PRBCs, with most of the differences occurring in the first 6 hours from admission and persisting though hospital discharge (Table 3 and Fig. 1). Similar to the FFP:PRBC ratios, mortality decreased significantly when patients received higher early ratios of PLTs:PRBCs. Again, most of the differences occurred in the first 6 hours from admission (Table 3 and Fig. 2).
With higher early
Comments
Hemorrhage remains the leading cause of preventable death in trauma patients. Most trauma deaths are not preventable, about 80% in combat operations and >90% in civilian traumas. Of the remaining potentially preventable deaths, 45% to 85% are potentially salvageable hemorrhagic deaths, most of which occur in the first 6 hours after injury.1, 2, 10, 12, 13, 14 It is this group of patients that this study is directed toward. Optimal treatment of these severely injured patients is required. Rapid
Acknowledgments
The authors thank The Trauma Outcomes Group (TOG); J.B. Holcomb, C.E. Wade, M.S. Park, and K.L. Williams from the United States Army Institute of Surgical Research and Brooke Army Medical Center, FT Sam, Houston, TX; E.A. Gonzalez and R.A. Kozar from the University of Texas Health Science Center, Houston, TX; J.E. Michalek, G.B. Chisholm, L.A. Zarzabal, R.M. Stewart, and S.M. Cohn from the University of Texas Health Science Center, San Antonio, TX; J.P. Minei and T. O'Keefe from the University
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