Application of Damage Control Resuscitation Strategies to Patients with Severe Traumatic Hemorrhage: Review of Plasma to Packed Red Blood Cell Ratios at a Single Institution

Abstract

When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (≥0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.Graphical Abstract

Does a balanced transfusion ratio of plasma to packed red blood cells improve outcomes in both trauma and surgical patients? A meta-analysis of randomized controlled trials and observational studies

“…Sensitivity studies using leave one out analysis of 24-hour and 30-day/in-hospital mortality at different ratios were done. (Supplementary figure 3) Morbidity ARDS data was available from 8 studies 2,14,28,29,35,40,45,46 and ALI data was reported in 2 studies 14,28 . There was no difference in the incidence of ARDS with respect to FFP: RBC ratio (OR: 0.68, CI 0.40-1.16, P=0.16).…”

Damage control resuscitation: lessons learned

“…Whilst such protocols have been found to reduce morbidity and mortality, [ 35 ] the requirement for such large amounts of clotting products and the exact composition of this transfusion regime does remain controversial [ 36 ]. An observational study recently demonstrated the early survival benefits of delivering clotting product to red cell ratios above 0.5:1 in patients with severe haemorrhage [ 37 ]. Conversely, recent military evidence suggests that ratios of a low as 0.35:1 may be preferable [ 38 ].…”

Single‐donor spray‐dried plasma

“…Plasma contains all proteins involved in secondary hemostasis and the essential von Willebrand factor (vWF) for initiating primary hemostasis and stabilizing Factor (F) VIII in secondary hemostasis. Rapid replenishment of plasma loss is critical in the acute phase of trauma/hemorrhage under damage control resuscitation practice . Currently, fresh frozen plasma (FFP) and plasma frozen within 24 hours are the most commonly used plasma products.…”