Early Aggressive Use of Fresh Frozen Plasma Does Not Improve Outcome in Critically Injured Trauma Patients

Pediatric trauma is the leading cause of death among children and adolescents. Unique variations in pediatric trauma patients require different approaches for pediatric patients than for adult patients. Early recognition of the subtle presentation of hemorrhagic shock is critical to initiate adequate resuscitation. The early use of blood transfusions is indicated for those nonresponsive to crystalloid boluses. Standard of care targets a goal of balanced administration of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT): 1PRBC:1FFP:1PLT. Thromboelastography (TEG) and tranexamic acid (TXA) may have a role in the management of children in hemorrhagic shock.

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Experience with uncrossmatched blood refrigerator in emergency department

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000184 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000184 ◽

Cited By ~ 1

Author(s):

Charles T Harris ◽

Michael Totten ◽

Daniel Davenport ◽

Zhan Ye ◽

Julie O’Brien ◽

...

Keyword(s):

Emergency Department ◽

Clinical Judgment ◽

Fresh Frozen Plasma ◽

Trauma Patients ◽

Provider Education ◽

Level Of Evidence ◽

Ready Availability ◽

Fresh Frozen ◽

Level I ◽

Frozen Plasma

BackgroundUncrossmatched packed red blood cell (PRBC) transfusion is fundamental in resuscitation of hemorrhagic shock. Ready availability of uncrossmatched blood can be achieved by storing uncrossmatched blood in a blood bank refrigerator in the emergency department (ED), but could theoretically lead to inappropriate uncrossmatched use.MethodsThis retrospective study was performed at a level I trauma center from January 2013 to March 2014. Possibly inappropriate transfusion was defined as patients who received at least one unit of blood from the ED refrigerator and no more than two units of PRBC in the first 24 hours. Deaths within the first 24 hours were excluded. Patients who received blood from the ED refrigerator who received ≤2 units total in 24 hours were compared with those who received >2 units.Results158 adults received blood from the ED refrigerator. 140 (88.6%) were trauma patients. 37 (23.4%) received massive transfusion (MT). 42 (26.6%) deaths were excluded. 29 patients received ≤2 units and 87 received >2 units in the first 24 hours. The ≤2 units group had a higher systolic blood pressure (116 mm Hg vs. 102 mm Hg, p=0.042), lower base deficit (6.4 mEq/L vs. 9.4 mEq/L, p=0.032), higher hematocrit (34% vs. 30%, p=0.024), lower rate of MT protocol activation (27.6% vs. 58.6%, p=0.005), and lower rates of transfusion of fresh frozen plasma (17.2% vs. 54.0%, p=0.001) and platelets (13.8% vs. 39.1%, p=0.012). Appropriately transfused patients were more likely to have evidence of shock with active, non-compressible hemorrhage. Potentially inappropriate uses were more likely in patients either without evidence of hemorrhage or without signs of shock.DiscussionStoring uncrossmatched blood in the ED is an effective way to get PRBCs transfused quickly in hemorrhaging patients and is associated with a low rate of unnecessary uncrossmatched transfusion. Provider education and good clinical judgment are imperative to prevent unnecessary use.Level of evidenceLevel III, therapeutic.

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Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

10.21203/rs.3.rs-41760/v1 ◽

2020 ◽

Author(s):

Cyril PERNOD ◽

Laurie Fraticelli ◽

Guillaume Marcotte ◽

Bernard Floccard ◽

Thibaut Girardot ◽

...

Keyword(s):

Teaching Hospital ◽

Fresh Frozen Plasma ◽

Primary Objective ◽

Trauma Centre ◽

Trauma Patients ◽

Trauma Resuscitation ◽

All Cause Mortality ◽

Fresh Frozen ◽

Annual Proportion ◽

Frozen Plasma

Abstract Background: Uncontrolled haemorrhage is still the leading cause of preventable death following trauma. Coagulation resuscitation strategies can be plasma-based or fibrinogen concentrate-based. The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEM® in a trauma centre from a teaching hospital.Methods: This is a single-centre, retrospective study at a Trauma Resuscitation Unit (TRU) from a French teaching hospital. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period.Assessment of the annual proportion of patients transfused with more than 4 RBCs at 24h, proportion of application of high fresh frozen plasma (FFP):RBC ratio (≥ 1:2 ), and proportion of administration of fibrinogen with ROTEM® protocol and TXA was performed. The secondary objectives aimed at assessing differences between populations according to the FFP:RBC ratio applied and compare all-cause mortality at D30.Results: A total of 122 patients were included. Between 2011 and 2016, there was a significant decrease in the proportion of patients requiring at least 4 RBCs 24h after trauma (9% vs. 3%, Ptrend < 0.0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6h, Ptrend = 0.0056 and 86% vs. 56% at 24h, Ptrend = 0.0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. Adherence to the ROTEM® protocol for the administration of fibrinogen was significant. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio.Conclusion: From 2011 to 2016, an important evolution of practices occurred in the TRU including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM® protocol for fibrinogen administration.

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Adding AB Plasma Units to Emergency Release O Negative Red Blood Cells (RBC) Issued to the Emergency Department (ED)

Blood ◽

10.1182/blood.v118.21.4333.4333 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4333-4333

Author(s):

Jennifer C. Andrews ◽

Susan Weiss ◽

Maurene Viele ◽

Lawrence T Goodnough

Keyword(s):

Conflicts Of Interest ◽

Fresh Frozen Plasma ◽

Blood Component ◽

Trauma Patients ◽

Time Period ◽

Academic Hospitals ◽

Wastage Rate ◽

Fresh Frozen ◽

Level I ◽

Frozen Plasma

Abstract Abstract 4333 Background: Recent studies have shown improved mortality and decreased early coagulopathy in trauma patients with administration of RBCs, platelets and fresh frozen plasma in a 1:1:1 ratio (Shaz BH et al. Transfusion 2010;50:493–500). As a result, massive transfusion protocols (MTP) have become common at large academic institutions with level I trauma programs. Our institution recently added 2 units of AB plasma to our standard ED trauma cooler which contains 2 units of O negative RBCs and which is ordered by ED staff upon notification of an incoming trauma patient. The treating physicians can escalate blood component support by ordering an MTP if indicated. The purpose of this study was to assess the use and wastage of plasma and RBCs in the ED trauma cooler. Methods: Orders received for the trauma cooler from January 1 2011 to June 30 2011 at a large academic Trauma I center were reviewed retrospectively. Transfusions of RBC and plasma for each order were assessed as well as wastage of plasma or RBCs not transfused. Patients may have used more blood products than initially issued in the ED trauma cooler. Results: Ninety one orders were received for an ED trauma cooler during the 6-month period assessed. Fifteen (16%) of 91 orders resulted in transfusion of RBCs. Nine (10%) of 91 orders resulted in transfusion of plasma. Five of 182 (3%) plasma units issued were wasted because temperature parameters were exceeded before return to the transfusion service (TS). No untransfused RBC units were wasted and all were returned to available inventory. See table. The 15 O negative RBC units transfused from the ED trauma cooler during this time period represent 0.8% (15/1891) of our medical center's transfused O negative RBC units, and the 14 AB plasma units transfused or wasted from the ED trauma cooler represent 2% (14/573) of the AB plasma units transfused by the TS. Conclusion: Of the 48 academic hospitals participating in the 2009 University Health System Consortium (UHC) Efficient Blood Management Benchmarking Project, the published mean wastage of plasma was 3.36% (range 0.36% – 9.44%). Our 3% wastage rate for AB plasma in the ED trauma cooler was within this range. The addition of 2 units of AB plasma to the ED trauma cooler with 2 units of O negative RBCs was feasible at our institution with acceptable wastage of plasma and no undue strain on our supply and inventory of donor O negative RBC and AB plasma. Disclosures: No relevant conflicts of interest to declare.

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Crystalloid Resuscitation Improves Survival in Trauma Patients Receiving Low Ratios of Fresh Frozen Plasma to Packed Red Blood Cells

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318227f1c5 ◽

2011 ◽

Vol 71 ◽

pp. S380-S383 ◽

Cited By ~ 24

Author(s):

Nicholas Spoerke ◽

Joel Michalek ◽

Martin Schreiber

Keyword(s):

Red Blood Cells ◽

Blood Cells ◽

Fresh Frozen Plasma ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Fresh Frozen ◽

Frozen Plasma

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Transfusion of Packed Red Blood Cells and Fresh Frozen Plasma are Synergistic Risk Factors for Venous Thromboembolism in Trauma Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.08.526 ◽

2016 ◽

Vol 223 (4) ◽

pp. e209-e210

Author(s):

Charles A. Karcutskie ◽

Jonathan P. Meizoso ◽

Juliet J. Ray ◽

Davis B. Horkan ◽

Xiomara Ruiz ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Red Blood Cells ◽

Blood Cells ◽

Fresh Frozen Plasma ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Fresh Frozen ◽

Frozen Plasma

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The epidemiology of overtransfusion of red cells in trauma resuscitation patients in the context of a mature massive transfusion protocol

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01678-0 ◽

2021 ◽

Author(s):

Timothy Cowan ◽

Natasha Weaver ◽

Alexander Whitfield ◽

Liam Bell ◽

Amanda Sebastian ◽

...

Keyword(s):

Injury Severity ◽

Haemoglobin Concentration ◽

Fresh Frozen Plasma ◽

Trauma Patients ◽

Trauma Resuscitation ◽

Packed Red Blood Cells ◽

Clinical Consequences ◽

Fresh Frozen ◽

Transfusion Protocol ◽

Frozen Plasma

Abstract Purpose Packed red blood cell (PRBC) transfusion remains an integral part of trauma resuscitation and an independent predictor of unfavourable outcomes. It is often administered urgently based on clinical judgement. These facts put trauma patients at high risk of potentially dangerous overtransfusion. We hypothesised that trauma patients are frequently overtransfused and overtransfusion is associated with worse outcomes. Methods Trauma patients who received PRBCs within 24 h of admission were identified from the trauma registry during the period January 1 2011–December 31 2018. Overtransfusion was defined as haemoglobin concentration of greater than or equal to 110 g/L at 24 h post ED arrival (± 12 h). Demographics, injury severity, injury pattern, shock severity, blood gas values and outcomes were compared between overtransfused and non-overtransfused patients. Results From the 211 patients (mean age 45 years, 71% male, ISS 27, mortality 12%) who met inclusion criteria 27% (56/211) were overtransfused. Patients with a higher pre-hospital systolic blood pressure (112 vs 99 mmHg p < 0.01) and a higher initial haemoglobin concentration (132 vs 124 p = 0.02) were more likely to be overtransfused. Overtransfused patients received smaller volumes of packed red blood cells (5 vs 7 units p = 0.049), fresh frozen plasma (4 vs 6 units p < 0.01) and cryoprecipitate (6 vs 9 units p = 0.01) than non-overtransfused patients. Conclusion More than a quarter of patients in our cohort were potentially given more blood products than required without obvious clinical consequences. There were no clinically relevant associations with overtransfusion.

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