A 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

Massive transfusion is defined as transfusion of 3 units of packed red blood cells in less than 1 hour in an adult, replacement of more than 1 blood volume in 24 hours, or replacement of more than 50% of blood volume in 3 hours. Massive transfusion protocols are implemented in cases of life-threatening hemorrhage after trauma, during a surgical procedure, or during childbirth. These protocols are intended to minimize the adverse effects of hypovolemia, dilutional anemia, metabolic complications, and coagulopathy with early empiric replacement of blood products and transfusion of fresh frozen plasma, platelets, and packed red blood cells in a composition that approximates that of whole blood.

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When Enough is Enough: Impact of Packed Red Blood Cells in Massive Transfusion Outcomes

The American Surgeon ◽

10.1177/000313481307900824 ◽

2013 ◽

Vol 79 (8) ◽

pp. 810-814 ◽

Cited By ~ 2

Author(s):

Kira Long ◽

Jiselle Bock Heaney ◽

Eric R. Simms ◽

Norman E. McSwain ◽

Juan C. Duchesne

Keyword(s):

Red Blood Cells ◽

Blood Cells ◽

Survival Benefit ◽

Massive Transfusion ◽

Fresh Frozen Plasma ◽

Survival Advantage ◽

Packed Red Blood Cells ◽

Fresh Frozen ◽

Level I ◽

The Impact

Massive transfusion protocol (MTP) with fresh-frozen plasma and packed red blood cells (PRBCs) in a 1:1 ratio is one of the most common resuscitative strategies used in patients with severe hemorrhage. There are no studies to date that examine the best postoperative hematocrit range as a marker for survival after MTP. We hypothesize a postoperative hematocrit dose-dependent survival benefit in patients receiving MTP. This was a 53-month retrospective analysis of patients with intra-abdominal injuries requiring surgery and transfusion of 10 units PRBCs or more at a single Level I trauma center. Groups were defined by postoperative hematocrit (less than 21, 21 to 29, 29.1 to 39, and 39 or more). Kaplan-Meier (KM) survival probability was calculated. One hundred fifty patients requiring operative abdominal explorations and 10 units PRBCs or more were identified. There were no significant differences in demographics between groups. When comparing postoperative hematocrit groups, relative to a hematocrit of less than 21 per cent in KM survival analysis, an overall survival advantage was only evident in patients transfused to hematocrits 29.1 to 39 per cent ( P < 0.03; odds ratio [OR], 0.284; 95% confidence interval [CI], 0.089 to 0.914). This survival advantage was not seen in the other groups (21 to 29: OR, 0.352; 95% CI, 0.103 to 1.195 or 39% or greater: OR, 0.107; 95% CI, 0.010 to 1.121). This is the first study to examine the impact of postoperative hematocrit as an indicator of survival after MTP in the trauma patient. Transfusion to hematocrits between 29.1 and 39 per cent conveyed a survival benefit, whereas resuscitation to supraphysiologic hematocrits 39 per cent or greater conveyed no additional survival benefit. This study highlights the need for judicious PRBC administration during MTP and its potential impact on survival in patients with postoperative supraphysiologic hematocrits.

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Potential effects of high plasma to red blood cell ratio transfusion in pediatric trauma

Trauma ◽

10.1177/1460408616645613 ◽

2016 ◽

Vol 19 (1) ◽

pp. 21-27 ◽

Cited By ~ 3

Author(s):

Ruth S Hwu ◽

Martin S Keller ◽

Philip C Spinella ◽

David Baker ◽

Yu Tao ◽

...

Keyword(s):

Hospital Mortality ◽

Red Blood Cells ◽

Blood Cells ◽

Massive Transfusion ◽

Pediatric Trauma ◽

Retrospective Chart Review ◽

High Plasma ◽

High Ratio ◽

Total Blood ◽

Significant Difference

Objective High ratio of plasma to red blood cells during massive transfusion is associated with improved survival of traumatic injuries in adults, but this has not been demonstrated in children. Our objective was to compare the outcome of children who received high (≥1:2) versus low (<1:2) plasma: red blood cells (P:R) ratios at 24 h from injury. Methods We conducted a retrospective chart review of children <18 years of age who presented to the emergency department over a 7-year period and received massive transfusion (≥40 ml/kg red blood cells or ≥80 ml/kg total blood products in 24 h). Our primary outcome of interest was in-hospital mortality. Results We identified 38 children who received massive transfusion. There was no significant difference in in-hospital mortality (45.8% vs. 64.3%) between the high (n = 24, median ratio 1:1.1) and low P:R ratio (n = 14, median 1:3.2) groups. In subset analyses, there was reduced mortality for high P:R patients with BIG score ≥24 (69.2% vs. 100%) and those taken to the operating room within 6 h of arrival (21.4% vs. 60.0%), respectively ( p < 0.05). There was a trend for improved survival in high P:R patients without severe traumatic brain injury (TBI) (0% vs. 40.0%). Conclusions This study suggests that high P:R transfusion may improve in-hospital survival of injured children at high risk of mortality and in children without severe TBI, supporting the need for large, multi-center studies.

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