The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients

Eur J Trauma Emerg Surg. 2017 Jun;43(3):393-398. doi: 10.1007/s00068-016-0674-5. Epub 2016 Apr 27.

Abstract

Purpose: High ratios of Plasma to Packed Red Blood Cells (FFP:PRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy.

Methods: Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFP:PRBC ratio cut-offs (1:2 and 1:3) and adjusted mortality derived.

Results: Over 8 years, 29 % (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFP:PRBC ratios (45 % for ratio ≤1:8, 33 % for ratio >1:8 and ≤1:3, 27 % for ratio >1:3 and ≤1:2 and 25 % for ratio >1:2). Increasing FFP:PRBC ratio independently predicted survival (AOR [95 % CI]: 1.91 [1.35-2.71]; p < 0.001). Patients achieving a ratio >1:3 had improved survival (AOR [95 % CI]: 3.24 [1.24-8.47]; p = 0.016).

Conclusion: In non-trauma patients undergoing massive transfusion, increasing FFP:PRBC ratio was associated with improved survival. A ratio >1:3 significantly improved survival probability.

Keywords: Blood components ratio; Emergency surgery; Massive transfusion; Plasma.

MeSH terms

  • Blood Component Transfusion / mortality*
  • Emergency Treatment
  • Erythrocytes*
  • Female
  • Hemorrhage / therapy*
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Procedures
  • Plasma*
  • Postoperative Complications / therapy
  • Resuscitation / mortality*
  • Survival Analysis
  • United States