Conflict of interest statement: there are no conflicts of interest associated with this article.
Red blood cell to plasma ratios transfused during massive transfusion are associated with mortality in severe multiply injury: a retrospective analysis from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie
Article first published online: 28 JUN 2008
© 2008 The Author(s). Journal compilation © 2008 Blackwell Publishing Ltd
Volume 95, Issue 2, pages 112–119, August 2008
How to Cite
Maegele, M., Lefering, R., Paffrath, T., Tjardes, T., Simanski, C., Bouillon, B. and the Working Group on Polytrauma of the German Society of Trauma Surgery (DGU) (2008), Red blood cell to plasma ratios transfused during massive transfusion are associated with mortality in severe multiply injury: a retrospective analysis from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie. Vox Sanguinis, 95: 112–119. doi: 10.1111/j.1423-0410.2008.01074.x
- Issue published online: 9 JUL 2008
- Article first published online: 28 JUN 2008
- Received: 5 March 2008, revised 21 May 2008, accepted 21 May 2008
- multiply injury;
- RBC : FFP transfusion
Background To test whether an acute transfusion practice of packed red blood cells (pRBC) : fresh-frozen plasma (FFP) 1 : 1 would be associated with reduced mortality in acute bleeding multiply injury.
Methods Retrospective analysis using the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie 2002–2006) on primary admissions with substantial injury (Injury Severity Score > 16) and massive transfusion (> 10 pRBCs). Seven hundred thirteen patients were divided into three groups according to the pRBC : FFP ratio transfused, that is, (i) pRBC : FFP > 1·1; (ii) pRBC : FFP 0·9–1·1 (1 : 1); and (iii) pRBC : FFP < 0·9, and mortality rates were compared.
Results Four hundred ninety-seven (69·7%) of patients were male, the mean age was 40·1 (± 18·3) years. Injury characteristics and pathophysiological state upon emergency room arrival were comparable between groups. Out of 713, 484 patients had undergone massive transfusion with pRBC : FFP > 1·1, 114 with pRBC : FFP 0·9–1·1 (1 : 1), and 115 with pRBC : FFP < 0·9 ratios. Acute mortality (< 6 h) rates for pRBC : FFP > 1·1, pRBC : FFP 0·9–1·1 (1 : 1), and pRBC : FFP < 0·9 ratios were 24·6, 9·6 and 3·5% (P < 0·0001), 24-h mortality rates were 32·6, 16·7 and 11·3% (P < 0·0001), and 30-day mortality rates were 45·5, 35·1 and 24·3% (P < 0·001). The frequency for septic complications and organ failure was higher in the pRBC : FFP 0·9–1·1 (1 : 1) group, ventilator days and length of stays for intensive care unit and overall in-hospital were highest in the pRBC : FFP < 0·9 ratio group (P < 0·0005).
Conclusions An association between pRBC : FFP transfusion ratios and mortality to favour early aggressive FFP administration was observed. Further investigation is necessary prior to recommending routine 1 : 1 or more aggressive FFP use in exsanguinating patients.