The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis.

ABSTRACT

PURPOSE: Transfusion ratios approaching 11 FFPPRBC for trauma resuscitation have become the de facto standard of care. The aim of this study was to prospectively evaluate the effect of increasing ratios of FFPPRBC transfusion on survival for massively transfused civilian trauma patients as well as determine if time to reach the target ratio had any effect on outcomes. METHODS: This is a prospective, observational study of all trauma patients requiring a massive transfusion (≥10 PRBC in ≤24 h) at a level 1 trauma center over a 2.5-year period. The ratio of FFPPRBC was tracked hourly up to 24 h post-initiation of massive transfusion. A logistic regression model was utilized to identify the ideal ratio associated with mortality prediction. A stepwise logistic regression was performed to identify independent predictors of mortality. RESULTS: The study population was predominantly male (89 %) with a mean age of 34.8 ± 16. On admission, 22 % had a systolic blood pressure ≤90 mmHg, 47 % had a heart rate ≥120, and 25 % had a GCS ≤8. The overall mortality was 33 %. The ratio of FFPPRBC ≥ 11.5 was the second most important independent predictor of mortality for this population (R (2) = 0.59). Survivors had a higher FFPPRBC ratio at all times during the first 24 h of resuscitation. CONCLUSIONS: Achieving a ratio of FFPPRBC ≥ 11.5 after the initial 24 h of resuscitation significantly improves survival in massively transfused trauma patients compared to patients that achieved a ratio <11.5.