Resuscitate early with plasma and platelets or balance blood products gradually

Findings from the PROMMTT study

Deborah J. Del Junco, John B. Holcomb, Erin E. Fox, Karen J. Brasel, Herb A. Phelan, Eileen M. Bulger, Martin A. Schreiber, Peter Muskat, Louis H. Alarcon, Mitchell J. Cohen, Bryan A. Cotton, Charles E. Wade, John G. Myers, Mohammad H. Rahbar

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

BACKGROUND: The trauma transfusion literature has yet to resolve which is more important for hemorrhaging patients, transfusing plasma and platelets along with red blood cells (RBCs) early in resuscitation or gradually balancing blood product ratios. In a previous report of PROMMTT results, we found (1) plasma and platelet:RBC ratios increased gradually during the 6 hours following admission, and (2) patients achieving ratios more than 1:2 (relative to ratios G1:2) had significantly decreased 6-hour to 24-hour mortality adjusting for baseline and time-varying covariates. To differentiate the association of in-hospital mortality with early plasma or platelet transfusion from that with delayed but gradually balanced ratios, we developed a separate analytic approach. METHODS: Using PROMMTT data and multilevel logistic regression to adjust for center effects, we related in-hospital mortality to the early receipt of plasma or platelets within the first three to six transfusion units (including RBCs) and 2.5 hours of admission. We adjusted for the same covariates as in our previous report: Injury Severity Score (ISS), age, time and total number of blood product transfusions upon entry to the analysis cohort, and bleeding from the head, chest, or limb. RESULTS: Of 1,245 PROMMTT patients, 619 were eligible for this analysis. Early plasma was associated with decreased 24-hour and 30-day mortality (adjusted odds ratios of 0.47 [p = 0.009] and 0.44 [p = 0.002], respectively). Too few patients (24) received platelets early for meaningful assessment. In the subgroup of 222 patients receiving no early plasma but continuing transfusions beyond Hour 2.5, achieving gradually balanced plasma and platelet:RBC ratios of 1:2 or greater by Hour 4 was not associated with 30-day mortality (adjusted odds ratios of 0.9 and 1.1, respectively). There were no significant center effects. CONCLUSION: Plasma transfusion early in resuscitation had a protective association with mortality, whereas delayed but gradually balanced transfusion ratios did not. Further researchwill require considerably larger numbers of patients receiving platelets early.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1 SUPPL1
DOIs
StatePublished - 2013

Fingerprint

Blood Platelets
Erythrocytes
Mortality
Hospital Mortality
Resuscitation
Odds Ratio
Platelet Transfusion
Injury Severity Score
Patient Admission
Blood Transfusion
Cohort Studies
Thorax
Extremities
Logistic Models
Head
Hemorrhage
Wounds and Injuries

Keywords

  • Massive transfusion
  • Plasma
  • Platelets
  • PROMMTT
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Resuscitate early with plasma and platelets or balance blood products gradually : Findings from the PROMMTT study. / Del Junco, Deborah J.; Holcomb, John B.; Fox, Erin E.; Brasel, Karen J.; Phelan, Herb A.; Bulger, Eileen M.; Schreiber, Martin A.; Muskat, Peter; Alarcon, Louis H.; Cohen, Mitchell J.; Cotton, Bryan A.; Wade, Charles E.; Myers, John G.; Rahbar, Mohammad H.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1 SUPPL1, 2013.

Research output: Contribution to journalArticle

Del Junco, DJ, Holcomb, JB, Fox, EE, Brasel, KJ, Phelan, HA, Bulger, EM, Schreiber, MA, Muskat, P, Alarcon, LH, Cohen, MJ, Cotton, BA, Wade, CE, Myers, JG & Rahbar, MH 2013, 'Resuscitate early with plasma and platelets or balance blood products gradually: Findings from the PROMMTT study', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e31828fa3b9
Del Junco, Deborah J. ; Holcomb, John B. ; Fox, Erin E. ; Brasel, Karen J. ; Phelan, Herb A. ; Bulger, Eileen M. ; Schreiber, Martin A. ; Muskat, Peter ; Alarcon, Louis H. ; Cohen, Mitchell J. ; Cotton, Bryan A. ; Wade, Charles E. ; Myers, John G. ; Rahbar, Mohammad H. / Resuscitate early with plasma and platelets or balance blood products gradually : Findings from the PROMMTT study. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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abstract = "BACKGROUND: The trauma transfusion literature has yet to resolve which is more important for hemorrhaging patients, transfusing plasma and platelets along with red blood cells (RBCs) early in resuscitation or gradually balancing blood product ratios. In a previous report of PROMMTT results, we found (1) plasma and platelet:RBC ratios increased gradually during the 6 hours following admission, and (2) patients achieving ratios more than 1:2 (relative to ratios G1:2) had significantly decreased 6-hour to 24-hour mortality adjusting for baseline and time-varying covariates. To differentiate the association of in-hospital mortality with early plasma or platelet transfusion from that with delayed but gradually balanced ratios, we developed a separate analytic approach. METHODS: Using PROMMTT data and multilevel logistic regression to adjust for center effects, we related in-hospital mortality to the early receipt of plasma or platelets within the first three to six transfusion units (including RBCs) and 2.5 hours of admission. We adjusted for the same covariates as in our previous report: Injury Severity Score (ISS), age, time and total number of blood product transfusions upon entry to the analysis cohort, and bleeding from the head, chest, or limb. RESULTS: Of 1,245 PROMMTT patients, 619 were eligible for this analysis. Early plasma was associated with decreased 24-hour and 30-day mortality (adjusted odds ratios of 0.47 [p = 0.009] and 0.44 [p = 0.002], respectively). Too few patients (24) received platelets early for meaningful assessment. In the subgroup of 222 patients receiving no early plasma but continuing transfusions beyond Hour 2.5, achieving gradually balanced plasma and platelet:RBC ratios of 1:2 or greater by Hour 4 was not associated with 30-day mortality (adjusted odds ratios of 0.9 and 1.1, respectively). There were no significant center effects. CONCLUSION: Plasma transfusion early in resuscitation had a protective association with mortality, whereas delayed but gradually balanced transfusion ratios did not. Further researchwill require considerably larger numbers of patients receiving platelets early.",
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T1 - Resuscitate early with plasma and platelets or balance blood products gradually

T2 - Findings from the PROMMTT study

AU - Del Junco, Deborah J.

AU - Holcomb, John B.

AU - Fox, Erin E.

AU - Brasel, Karen J.

AU - Phelan, Herb A.

AU - Bulger, Eileen M.

AU - Schreiber, Martin A.

AU - Muskat, Peter

AU - Alarcon, Louis H.

AU - Cohen, Mitchell J.

AU - Cotton, Bryan A.

AU - Wade, Charles E.

AU - Myers, John G.

AU - Rahbar, Mohammad H.

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N2 - BACKGROUND: The trauma transfusion literature has yet to resolve which is more important for hemorrhaging patients, transfusing plasma and platelets along with red blood cells (RBCs) early in resuscitation or gradually balancing blood product ratios. In a previous report of PROMMTT results, we found (1) plasma and platelet:RBC ratios increased gradually during the 6 hours following admission, and (2) patients achieving ratios more than 1:2 (relative to ratios G1:2) had significantly decreased 6-hour to 24-hour mortality adjusting for baseline and time-varying covariates. To differentiate the association of in-hospital mortality with early plasma or platelet transfusion from that with delayed but gradually balanced ratios, we developed a separate analytic approach. METHODS: Using PROMMTT data and multilevel logistic regression to adjust for center effects, we related in-hospital mortality to the early receipt of plasma or platelets within the first three to six transfusion units (including RBCs) and 2.5 hours of admission. We adjusted for the same covariates as in our previous report: Injury Severity Score (ISS), age, time and total number of blood product transfusions upon entry to the analysis cohort, and bleeding from the head, chest, or limb. RESULTS: Of 1,245 PROMMTT patients, 619 were eligible for this analysis. Early plasma was associated with decreased 24-hour and 30-day mortality (adjusted odds ratios of 0.47 [p = 0.009] and 0.44 [p = 0.002], respectively). Too few patients (24) received platelets early for meaningful assessment. In the subgroup of 222 patients receiving no early plasma but continuing transfusions beyond Hour 2.5, achieving gradually balanced plasma and platelet:RBC ratios of 1:2 or greater by Hour 4 was not associated with 30-day mortality (adjusted odds ratios of 0.9 and 1.1, respectively). There were no significant center effects. CONCLUSION: Plasma transfusion early in resuscitation had a protective association with mortality, whereas delayed but gradually balanced transfusion ratios did not. Further researchwill require considerably larger numbers of patients receiving platelets early.

AB - BACKGROUND: The trauma transfusion literature has yet to resolve which is more important for hemorrhaging patients, transfusing plasma and platelets along with red blood cells (RBCs) early in resuscitation or gradually balancing blood product ratios. In a previous report of PROMMTT results, we found (1) plasma and platelet:RBC ratios increased gradually during the 6 hours following admission, and (2) patients achieving ratios more than 1:2 (relative to ratios G1:2) had significantly decreased 6-hour to 24-hour mortality adjusting for baseline and time-varying covariates. To differentiate the association of in-hospital mortality with early plasma or platelet transfusion from that with delayed but gradually balanced ratios, we developed a separate analytic approach. METHODS: Using PROMMTT data and multilevel logistic regression to adjust for center effects, we related in-hospital mortality to the early receipt of plasma or platelets within the first three to six transfusion units (including RBCs) and 2.5 hours of admission. We adjusted for the same covariates as in our previous report: Injury Severity Score (ISS), age, time and total number of blood product transfusions upon entry to the analysis cohort, and bleeding from the head, chest, or limb. RESULTS: Of 1,245 PROMMTT patients, 619 were eligible for this analysis. Early plasma was associated with decreased 24-hour and 30-day mortality (adjusted odds ratios of 0.47 [p = 0.009] and 0.44 [p = 0.002], respectively). Too few patients (24) received platelets early for meaningful assessment. In the subgroup of 222 patients receiving no early plasma but continuing transfusions beyond Hour 2.5, achieving gradually balanced plasma and platelet:RBC ratios of 1:2 or greater by Hour 4 was not associated with 30-day mortality (adjusted odds ratios of 0.9 and 1.1, respectively). There were no significant center effects. CONCLUSION: Plasma transfusion early in resuscitation had a protective association with mortality, whereas delayed but gradually balanced transfusion ratios did not. Further researchwill require considerably larger numbers of patients receiving platelets early.

KW - Massive transfusion

KW - Plasma

KW - Platelets

KW - PROMMTT

KW - Trauma

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