An FFP: PRBC transfusion ratio ≥1:1.5 is associated with a lower risk of mortality after massive transfusion

Jason L. Sperry, Juan B. Ochoa, Scott R. Gunn, Louis H. Alarcon, Joseph P. Minei, Joseph Cuschieri, Matthew R. Rosengart, Ronald V. Maier, Timothy R. Billiar, Andrew B. Peitzman, Ernest E. Moore

Research output: Contribution to journalArticle

263 Citations (Scopus)

Abstract

OBJECTIVE:: The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS:: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required ĝ‰¥8 units PRBCs within the first 12 hours postinjury were analyzed (n ≤ 415). RESULTS:: Patients who received transfusion products in ĝ‰¥1:1.50 FFP:PRBC ratio (high F:P ratio, n ≤ 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n ≤ 313) required significantly less blood transfusion at 24 hours (16 ± 9 units vs. 22 ± 17 units, p ≤ 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p ≤ 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p ≤ 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p ≤ 0.002, 95% CI 0.3ĝ€"0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders. CONCLUSIONS:: In patients requiring ĝ‰¥8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio ĝ‰¥1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.

Original languageEnglish (US)
Pages (from-to)986-993
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume65
Issue number5
DOIs
StatePublished - Nov 2008

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Erythrocyte Transfusion
Mortality
Erythrocytes
Adult Respiratory Distress Syndrome
Hemorrhage
Nonpenetrating Wounds
Hemorrhagic Shock
Wounds and Injuries
Risk Reduction Behavior
Cross Infection
Acidosis
Hypothermia
Blood Transfusion
Cohort Studies
Prospective Studies

Keywords

  • Cox proportional hazard regression
  • Massive transfusion
  • Plasma
  • Transfusion ratio

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

An FFP : PRBC transfusion ratio ≥1:1.5 is associated with a lower risk of mortality after massive transfusion. / Sperry, Jason L.; Ochoa, Juan B.; Gunn, Scott R.; Alarcon, Louis H.; Minei, Joseph P.; Cuschieri, Joseph; Rosengart, Matthew R.; Maier, Ronald V.; Billiar, Timothy R.; Peitzman, Andrew B.; Moore, Ernest E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 65, No. 5, 11.2008, p. 986-993.

Research output: Contribution to journalArticle

Sperry, JL, Ochoa, JB, Gunn, SR, Alarcon, LH, Minei, JP, Cuschieri, J, Rosengart, MR, Maier, RV, Billiar, TR, Peitzman, AB & Moore, EE 2008, 'An FFP: PRBC transfusion ratio ≥1:1.5 is associated with a lower risk of mortality after massive transfusion', Journal of Trauma - Injury, Infection and Critical Care, vol. 65, no. 5, pp. 986-993. https://doi.org/10.1097/TA.0b013e3181878028
Sperry, Jason L. ; Ochoa, Juan B. ; Gunn, Scott R. ; Alarcon, Louis H. ; Minei, Joseph P. ; Cuschieri, Joseph ; Rosengart, Matthew R. ; Maier, Ronald V. ; Billiar, Timothy R. ; Peitzman, Andrew B. ; Moore, Ernest E. / An FFP : PRBC transfusion ratio ≥1:1.5 is associated with a lower risk of mortality after massive transfusion. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 65, No. 5. pp. 986-993.
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abstract = "OBJECTIVE:: The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS:: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required ĝ‰¥8 units PRBCs within the first 12 hours postinjury were analyzed (n ≤ 415). RESULTS:: Patients who received transfusion products in ĝ‰¥1:1.50 FFP:PRBC ratio (high F:P ratio, n ≤ 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n ≤ 313) required significantly less blood transfusion at 24 hours (16 ± 9 units vs. 22 ± 17 units, p ≤ 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28{\%} vs. low F:P 35{\%}, p ≤ 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9{\%} vs. low F:P 12.8{\%}, p ≤ 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52{\%} lower risk of mortality after adjusting for important confounders (HR 0.48, p ≤ 0.002, 95{\%} CI 0.3ĝ€{"}0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders. CONCLUSIONS:: In patients requiring ĝ‰¥8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio ĝ‰¥1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.",
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T2 - PRBC transfusion ratio ≥1:1.5 is associated with a lower risk of mortality after massive transfusion

AU - Sperry, Jason L.

AU - Ochoa, Juan B.

AU - Gunn, Scott R.

AU - Alarcon, Louis H.

AU - Minei, Joseph P.

AU - Cuschieri, Joseph

AU - Rosengart, Matthew R.

AU - Maier, Ronald V.

AU - Billiar, Timothy R.

AU - Peitzman, Andrew B.

AU - Moore, Ernest E.

PY - 2008/11

Y1 - 2008/11

N2 - OBJECTIVE:: The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS:: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required ĝ‰¥8 units PRBCs within the first 12 hours postinjury were analyzed (n ≤ 415). RESULTS:: Patients who received transfusion products in ĝ‰¥1:1.50 FFP:PRBC ratio (high F:P ratio, n ≤ 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n ≤ 313) required significantly less blood transfusion at 24 hours (16 ± 9 units vs. 22 ± 17 units, p ≤ 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p ≤ 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p ≤ 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p ≤ 0.002, 95% CI 0.3ĝ€"0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders. CONCLUSIONS:: In patients requiring ĝ‰¥8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio ĝ‰¥1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.

AB - OBJECTIVE:: The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS:: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required ĝ‰¥8 units PRBCs within the first 12 hours postinjury were analyzed (n ≤ 415). RESULTS:: Patients who received transfusion products in ĝ‰¥1:1.50 FFP:PRBC ratio (high F:P ratio, n ≤ 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n ≤ 313) required significantly less blood transfusion at 24 hours (16 ± 9 units vs. 22 ± 17 units, p ≤ 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p ≤ 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p ≤ 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p ≤ 0.002, 95% CI 0.3ĝ€"0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders. CONCLUSIONS:: In patients requiring ĝ‰¥8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio ĝ‰¥1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.

KW - Cox proportional hazard regression

KW - Massive transfusion

KW - Plasma

KW - Transfusion ratio

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