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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

World Journal of Emergency Surgery 1/2015

Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time

Zeitschrift:
World Journal of Emergency Surgery > Ausgabe 1/2015
Autoren:
Ruben Peralta, Adarsh Vijay, Ayman El-Menyar, Rafael Consunji, Husham Abdelrahman, Ashok Parchani, Ibrahim Afifi, Ahmad Zarour, Hassan Al-Thani, Rifat Latifi
Wichtige Hinweise

Competing interests

The author(s) declare that they have no competing interests.

Authors’ contributions

RP: study design data interpretation, and manuscript drafting; AV: study design data interpretation, and manuscript drafting; AE: data analysis and interpretation, drafting and manuscript review; RC: study design data interpretation, and manuscript drafting; HA: data analysis, interpretation, and drafting; AP: was involved in study design, data collection and writing manuscript; IA: was involved in study design, data collection and writing manuscript; AZ: data analysis, interpretation, and drafting, HA: study design, data interpretation, and review manuscript, AP: study design data interpretation, and manuscript review; and RL: study design data interpretation, and manuscript review. All authors read and approved the final manuscript.

Authors’ information

RP: Trauma Surgery Section, Hamad General Hospital, Qatar; AV: Trauma Surgery Section, Hamad General Hospital, Qatar; AE: Clinical Research, Trauma Surgery Section, Hamad General Hospital, Qatar and Weill Cornell Medical School, Doha, Qatar; RC: Trauma Surgery Section, Hamad General Hospital, Qatar; HA: Trauma Surgery Section, Hamad General Hospital, Qatar; AP: Trauma Surgery Section, Hamad General Hospital, Qatar; IA: Trauma Surgery Section, Hamad General Hospital, Qatar; AZ: Trauma Surgery Section, Hamad General Hospital, Qatar; HA: Trauma Surgery Section, Hamad General Hospital, Qatar; RL: Trauma Surgery Section, Hamad General Hospital, Qatar and Department of Surgery, Arizona University, Tucson, AZ, USA.

Abstract

Objective

We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).

Methods

A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.

Results

During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

Conclusions

Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.
Literatur
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