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Red blood cell to plasma ratios transfused during massive transfusion are associated with mortality in severe multiply injury: a retrospective analysis from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie
Author(s) -
Maegele M.,
Lefering R.,
Paffrath T.,
Tjardes T.,
Simanski C.,
Bouillon B.
Publication year - 2008
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/j.1423-0410.2008.01074.x
Subject(s) - medicine , fresh frozen plasma , injury severity score , packed red blood cells , retrospective cohort study , blood transfusion , mortality rate , surgery , emergency medicine , poison control , injury prevention , platelet
Background To test whether an acute transfusion practice of packed red blood cells (pRBC) : fresh‐frozen plasma (FFP) 1 : 1 would be associated with reduced mortality in acute bleeding multiply injury. Methods Retrospective analysis using the TR‐DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie 2002–2006) on primary admissions with substantial injury (Injury Severity Score > 16) and massive transfusion (> 10 pRBCs). Seven hundred thirteen patients were divided into three groups according to the pRBC : FFP ratio transfused, that is, (i) pRBC : FFP > 1·1; (ii) pRBC : FFP 0·9–1·1 (1 : 1); and (iii) pRBC : FFP < 0·9, and mortality rates were compared. Results Four hundred ninety‐seven (69·7%) of patients were male, the mean age was 40·1 (± 18·3) years. Injury characteristics and pathophysiological state upon emergency room arrival were comparable between groups. Out of 713, 484 patients had undergone massive transfusion with pRBC : FFP > 1·1, 114 with pRBC : FFP 0·9–1·1 (1 : 1), and 115 with pRBC : FFP < 0·9 ratios. Acute mortality (< 6 h) rates for pRBC : FFP > 1·1, pRBC : FFP 0·9–1·1 (1 : 1), and pRBC : FFP < 0·9 ratios were 24·6, 9·6 and 3·5% ( P < 0·0001), 24‐h mortality rates were 32·6, 16·7 and 11·3% ( P < 0·0001), and 30‐day mortality rates were 45·5, 35·1 and 24·3% ( P < 0·001). The frequency for septic complications and organ failure was higher in the pRBC : FFP 0·9–1·1 (1 : 1) group, ventilator days and length of stays for intensive care unit and overall in‐hospital were highest in the pRBC : FFP < 0·9 ratio group ( P < 0·0005). Conclusions An association between pRBC : FFP transfusion ratios and mortality to favour early aggressive FFP administration was observed. Further investigation is necessary prior to recommending routine 1 : 1 or more aggressive FFP use in exsanguinating patients.