Authors: Simms ER et al., J Am Coll Surg 2014 Aug 219:181
For trauma patients who present with severe hemorrhage, using a FFP:PRBC ratio ≥0.7 during resuscitation may be beneficial.
Research has shown that using higher ratios of fresh frozen plasma (FFP) and platelets to packed red blood cells (PRBCs) in the resuscitation of exsanguinating trauma patients improves survival; however, this effect may merely reflect survival bias (NEJM JW Emerg Med May 8 2009). In an effort to reduce this effect, researchers retrospectively measured mean infusion rates of blood products (total volume divided by time in emergency department [ED] or operating room) in 151 trauma patients with severe hemorrhage who received more than 10 units of PRBCs within 24 hours of ED arrival and underwent emergent damage control surgery.
The overall survival rate at 180 minutes was 80%. Nonsurvivors had a higher mean Injury Severity Score than survivors (36 vs. 22) and a lower mean Glasgow Coma Scale score (6.3 vs. 11.9) and systolic blood pressure (82.1 vs. 108.7 mm Hg) at admission. Mean infusion rates were higher in survivors than nonsurvivors for FFP (92 vs. 34 mL/minute) and platelets (3.5 vs. 1.1 mL/minute). Survivors also received a higher ratio of FFP:PRBCs during resuscitation: survival rates were 87% with an FFP:PRBC ratio ≥0.7 versus 55% with a ratio <0.7.
While a higher ratio of plasma to red cell resuscitation may be beneficial for exsanguinating trauma patients, other factors, such as prehospital transport time, crystalloid resuscitation volume, blood product availability, and injury severity, limit this study’s generalizability. Until further studies elucidate the best transfusion strategy, limiting crystalloid resuscitation and rapidly transfusing blood products — preferably in a 1:1:1 ratio for PRBCs, FFP, and platelets — is prudent.