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Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME)
Author(s) -
de Biasi Andreas R.,
Stansbury Lynn G.,
Dutton Richard P.,
Stein Deborah M.,
Scalea Thomas M.,
Hess John R.
Publication year - 2011
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2010.03050.x
Subject(s) - resuscitation , medicine , blood product , injury severity score , blood transfusion , blood plasma , anesthesia , plasma levels , emergency medicine , poison control , injury prevention , surgery
BACKGROUND: Resuscitation of rapidly bleeding trauma patients with units of red blood cells (RBCs) and plasma given in a 1:1 ratio has been associated with improved outcome. However, demonstration of a benefit is confounded by survivor bias, and past work from our group has been unable to demonstrate a benefit. STUDY DESIGN AND METHODS: We identified 438 adult direct primary trauma admissions at risk for massive transfusion who received 5 or more RBC units in the first 24 hours and had a probability of survival of 0.010 to 0.975. We correlated survival with RBC and plasma use by hour, both as a ratio (units of plasma/units of RBC) and as a plasma deficit (units of RBC − units of plasma) in the group as a whole and among those using 5 to 9 and more than 9 units of RBCs. RESULTS: Resuscitation was essentially complete in 58.3% by the end of the third hour and 77.9% by the end of the sixth hour. Mortality by hour was significantly associated with worse plasma deficit status in the first 2 hours of resuscitation (p < 0.001 and p < 0.01) but not with plasma ratio. In a subgroup with a Trauma Revised Injury Severity Score of 0.200 to 0.800, early plasma repletion was associated with less blood product use independently of injury severity (p < 0.001). CONCLUSIONS: 1) The efficacy of plasma repletion plays out in the first few hours of resuscitation, 2) plasma deficit may be a more sensitive marker of efficacy in some populations, and 3) early plasma repletion appears to prevent some patients from going on to require massive transfusion.