Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival.

ABSTRACT

BACKGROUND: Despite recent attention and impressive results with damage control resuscitation, the appropriate ratio of blood products to be transfused has yet to be defined. The purpose of this study was to evaluate whether suggested blood product ratios yield superior survival rates. MATERIALS After IRB approval, a retrospective evaluation was performed on all trauma exsanguination protocol (TEP, n = 118) activations from February 1, 2006 to July 31, 2007. A comparison cohort (pre-TEP, n = 140) was selected from all trauma admissions between August 1, 2004 and January 31, 2006 that (1) underwent immediate surgery by the trauma team and (2) received greater than 10 units of PRBC in the first 24 hours. We then compared those who received FFPRBC (23) and plateletRBC (15) ratios with those who did not reach these ratios. Multivariate analysis was performed for independent predictors of mortality. RESULTS: A total of 259 patients were available for study. Patients receiving FFPRBC at a ratio of 23 or greater (n = 64) had a significant reduction in 30-day mortality compared with those who received less than a 23 ratio (n = 195); 41% versus 62%, p = 0.008. Patients receiving plateletsRBC at a ratio of 15 or greater (n = 63) had a lower 30-day mortality when compared with those with who received less than this ratio (n = 196); (38% vs. 61%, p = 0.001). Regression model demonstrated that a ratio of FFP to PRBC is an independent predictor of 30-day mortality, controlling for age and TRISS (OR 1.78, 95% CI 1.01-3.14). CONCLUSIONS: Increased FFPPRBC and PLTPRBC ratios during a period of massive transfusion improved survival after major trauma. Massive transfusion protocols should be designed to achieve these ratios to provide maximal benefit.