Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time

World Journal of Emergency Surgery

Rifat Latifi²  Hassan Al-Thani¹  Ahmad Zarour³  Ibrahim Afifi¹  Ashok Parchani¹  Husham Abdelrahman¹  Rafael Consunji¹  Ayman El-Menyar³  Adarsh Vijay¹  Ruben Peralta¹ 

[1] Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar;Department of Surgery, University of Arizona, Tucson, AZ, USA;Clinical Medicine, Weill Cornell Medical College, Doha, Qatar

关键词: Outcome;    Massive transfusion protocol;    Transfusion ratio;    Trauma;   

Others  :  1225520
DOI  :  10.1186/s13017-015-0028-3

 received in 2015-03-24, accepted in 2015-07-23,  发布年份 2015

【 摘 要 】

Objective

We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).

Methods

A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.

Results

During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

Conclusions

Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.

【 授权许可】

   
2015 Peralta et al.

【 图 表 】

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