Association Between Ratio of Fresh Frozen Plasma to Red Blood Cells During Massive Transfusion and Survival Among Patients Without Traumatic Injury

Mesar, Tomaž; Larentzakis, Andreas; Dzik, Walter; Chang, Yuchiao; Velmahos, George C.; Yeh, D. Dante

doi:10.1001/jamasurg.2017.0098

Cited by 65 publications

(47 citation statements)

References 17 publications

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“…Given the extensive literature and debate on the value of FFP in trauma, it may be more beneficial to use gelsolin in isolation to scavenge excess actin and restore DNase activity. Indeed, low plasma gelsolin levels on admission to hospital following trauma have been associated with poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury

Dinsdale

Hazeldine

Tarrah

et al. 2020

Journal of British Surgery

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Background Circulating cell‐free DNA (cfDNA) is not found in healthy subjects, but is readily detected after thermal injury and may contribute to the risk of multiple organ failure. The hypothesis was that a postburn reduction in DNase protein/enzyme activity could contribute to the increase in cfDNA following thermal injury. Methods Patients with severe burns covering at least 15 per cent of total body surface area were recruited to a prospective cohort study within 24 h of injury. Blood samples were collected from the day of injury for 12 months. Results Analysis of blood samples from 64 patients revealed a significant reduction in DNase activity on days 1–28 after injury, compared with healthy controls. DNase protein levels were not affected, suggesting the presence of an enzyme inhibitor. Further analysis revealed that actin (an inhibitor of DNase) was present in serum samples from patients but not those from controls, and concentrations of the actin scavenging proteins gelsolin and vitamin D‐binding protein were significantly reduced after burn injury. In a pilot study of ten military patients with polytrauma, administration of blood products resulted in an increase in DNase activity and gelsolin levels. Conclusion The results of this study suggest a novel biological mechanism for the accumulation of cfDNA following thermal injury by which high levels of actin released by damaged tissue cause a reduction in DNase activity. Restoration of the actin scavenging system could therefore restore DNase activity, and reduce the risk of cfDNA‐induced host tissue damage and thrombosis.

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Section: Discussionmentioning

confidence: 99%

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury

Dinsdale

Hazeldine

Tarrah

et al. 2020

Journal of British Surgery

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“…80,81 A large retrospective review of experience before and after implementation of 1:1 resuscitation failed to show a mortality benefit. 82 The Canadian consensus conference on massive transfusion recommended an RBC:plasma ratio of 2:1 followed by transition to laboratory-guided administration of blood components as soon as possible. 83 The standard approach outlined below, which is based on expert consensus, is applicable to most large adult hospitals.…”

Section: In Bleeding Patients In Need Of Red Blood Cell Transfusionmentioning

confidence: 99%

A regional massive hemorrhage protocol developed through a modified Delphi technique

Callum

Petrosoniak²,

McVey³

et al. 2019

cmajo

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assive bleeding is a leading preventable cause of death following trauma, childbirth and surgery. 1-3 There were 5.1 million deaths after traumatic injury worldwide in 2010, mostly affecting young people, accounting for nearly 10% of all deaths. 4 In the United States, it is estimated that up to 20% of such deaths are the direct result of preventable hemorrhage. 4-7 Management of unstable hemorrhagic shock is centred on stabilizing the patient with prompt transfusion of blood components, and rapid identification and treatment of the source of bleeding. Patient outcome is dependent on the availability of rapid definitive surgical intervention, support of a transfusion medicine and clinical laboratory, prompt access to hemostatic agents and care provided by a high-performing interdisciplinary team. 8 In the trauma literature, protocolized delivery of massive transfusion streamlines the complexities

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“…Patients undergoing surgery, including cardiothoracic and gastrointestinal (GI) surgery, are the greatest recipients of MTs (Halmin et al, 2016;Ruseckaite et al, 2017). Despite being the focus of most of the research, trauma patients receive <20% of all MTs (Zatta et al, 2014;Halmin et al, 2016;Mesar et al, 2017;Ruseckaite et al, 2017). Although hospitals often maintain emergency blood supplies for use in obstetrics, and this drives many inventory management decisions, major post-partum haemorrhage requiring MT is fortunately rare -in the UK, this has been reported to be just 23 cases per 100 000 maternity admissions (Green et al, 2016b), and obstetric patients receive <6% of all MTs (Halmin et al, 2016;Ruseckaite et al, 2017).…”

Section: The Epidemiology Of Massive Transfusionsmentioning

confidence: 99%

“…() conducted a retrospective study of 62 trauma and 63 non‐trauma patients and found that transfusion ratio was not associated with mortality for either patient cohort. In another retrospective study of both trauma and non‐trauma patients, of 865 patients who received MTs (defined as >10 units of RBCs in 24 h) over 4 years, 767 (88·7%) were classified as non‐trauma, and there was no difference in 30‐day mortality comparing higher ratios to lower ratios (Mesar et al, ). When considering individual non‐trauma subgroups, there was a reduced risk of mortality for higher ratios in the vascular subgroup and a reduced risk of mortality for lower ratios for the medicine and general surgery subgroups (Baumann Kreuziger et al, ).…”

Section: Blood Component and Coagulation Factor Supportmentioning

confidence: 99%

Massive transfusions for critical bleeding: is everything old new again?

Flint

McQuilten

Wood

2018

Transfusion Medicine

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Massive transfusion or major haemorrhage protocols have been widely adopted in the treatment of critically bleeding patients. Following evidence that higher ratios of transfused plasma and platelets to red blood cells may offer survival benefits in military trauma patients, these ratios are now commonly incorporated into massive transfusion protocols. They more closely resemble the effects of whole blood transfusion, which in the second half of last century was largely replaced by individual blood component transfusion based on laboratory-guided indicators. However, high-quality evidence to guide transfusion support for critically bleeding patients across the range of bleeding contexts is lacking, including for both trauma and non-trauma patients. More data on major haemorrhage support and clinical outcomes are needed to inform guidelines and practice.

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Association Between Ratio of Fresh Frozen Plasma to Red Blood Cells During Massive Transfusion and Survival Among Patients Without Traumatic Injury

Abstract: High FFP:RBC transfusion ratios are applied mostly to patients without trauma, who account for nearly 90% of all massive transfusion events. Thirty-day survival was not significantly different in patients who received a high FFP:RBC ratio compared with those who received a low ratio.

Cited by 65 publications

References 17 publications

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury

Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury

A regional massive hemorrhage protocol developed through a modified Delphi technique

Massive transfusions for critical bleeding: is everything old new again?

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