Optimizing outcomes in damage control resuscitation

Identifying blood product ratios associated with improved survival

Oliver L. Gunter, Brigham K. Au, James M. Isbell, Nathan T. Mowery, Pampee P. Young, Bryan A. Cotton

Research output: Contribution to journalArticle

241 Citations (Scopus)

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 FFP:RBC (2:3) and platelet:RBC (1:5) 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 FFP:RBC at a ratio of 2:3 or greater (n = 64) had a significant reduction in 30-day mortality compared with those who received less than a 2:3 ratio (n = 195); 41% versus 62%, p = 0.008. Patients receiving platelets:RBC at a ratio of 1:5 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 FFP:PRBC and PLT:PRBC 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.

Original languageEnglish (US)
Pages (from-to)527-532
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume65
Issue number3
DOIs
StatePublished - Sep 1 2008

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Resuscitation
Survival
Mortality
Wounds and Injuries
Blood Platelets
Exsanguination
Research Ethics Committees
Multivariate Analysis
Survival Rate
tetraethylpyrazine

Keywords

  • Exsanguination
  • Hemorrhage
  • Massive transfusion
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Optimizing outcomes in damage control resuscitation : Identifying blood product ratios associated with improved survival. / Gunter, Oliver L.; Au, Brigham K.; Isbell, James M.; Mowery, Nathan T.; Young, Pampee P.; Cotton, Bryan A.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 65, No. 3, 01.09.2008, p. 527-532.

Research output: Contribution to journalArticle

Gunter, Oliver L. ; Au, Brigham K. ; Isbell, James M. ; Mowery, Nathan T. ; Young, Pampee P. ; Cotton, Bryan A. / Optimizing outcomes in damage control resuscitation : Identifying blood product ratios associated with improved survival. In: Journal of Trauma - Injury, Infection and Critical Care. 2008 ; Vol. 65, No. 3. pp. 527-532.
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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 FFP:RBC (2:3) and platelet:RBC (1:5) 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 FFP:RBC at a ratio of 2:3 or greater (n = 64) had a significant reduction in 30-day mortality compared with those who received less than a 2:3 ratio (n = 195); 41{\%} versus 62{\%}, p = 0.008. Patients receiving platelets:RBC at a ratio of 1:5 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 FFP:PRBC and PLT:PRBC 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.",
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AU - Cotton, Bryan A.

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KW - Exsanguination

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