The Impact of Fresh Frozen Plasma to Packed Red Blood Cell Ratio on Mortality in Traumatic Hemorrhage: a Nationwide Analysis
*Charlie J Nederpelt, *Majed el Hechi, *Alexander Bonde, *Napaporn Kongkaewpaisan, *Nikos Kokoroskos, *April E. Mendoza, *Noelle N. Saillant, *Martin G. Rosenthal, *Peter J. Fagenholz, *David R. King, *David C. Chang, George V. Velmahos, Haytham M.A. Kaafarani
Massachusetts General Hospital, Boston, MA
Objective: The optimal ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) in trauma remains unclear. We sought to study the association between FFP:PRBC and early mortality in the hemorrhaging trauma patient.
Design: Retrospective nationwide cohort.
Setting: All TQIP participating hospitals (2013-2016).
Patients: We included
all trauma patients who were transfused ≥10 pRBCs and ≥1 FFP within 24 hours. We excluded transferred patients and those who died in the emergency department or had missing/inaccurate transfusion data. . Patients were assigned to six FFP:PRBC cohorts (range 1:1 to 1:6) only if the ratio was similar at 4 and 24 hours and were excluded otherwise.
Main Outcome Measure: Multivariable analyses correcting for all confounders [age, demographics, comorbidities, vital signs, injury severity scale (ISS) and mechanism, procedures performed] were derived to study the independent relationship between FFP:PRBC and 24-hour mortality.
Results: Out of 1,002,595 patients, 4,427 patients were included. Mean age was 40 years, 79% were males, 61% had blunt trauma, and median ISS was 29. Most patients were transfused in a 1:1, 1:2, or 1:3 ratio (31%, 41%, and 11%, respectively); mortality ranged between 28% for 1:1 and 62% for 1:4. In multivariable analyses, the odds of mortality independently and incrementally increased to 1.32 [1.05-1.68] for a 1:2 ratio, 1.85 [1.11-3.08] for 1:4, and as high as 3.32 [1.20-9.22] for 1:6 (Figure 1, all p<0.05).
Conclusions: A 1:1 FFP:PRBC ratio is associated with the lowest mortality in the hemorrhaging trauma patient and mortality gradually increases with decreasing ratios.
Back to 2019 Abstracts