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

Rahouma, Mohamed; Kamel, Mohamed; Jodeh, Diana S.; Kelley, Thomas M.; Ohmes, Lucas B.; Biasi, Andreas R. de; Abouarab, Ahmed; Benedetto, Umberto; Guy, T. Sloane; Lau, Christopher; Lee, Paul C.; Girardi, Leonard N.; Gaudino, Mario

doi:10.1016/j.amjsurg.2017.08.045

Cited by 26 publications

(31 citation statements)

References 44 publications

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“…This is the first meta‐analyses to report exposure to allogeneic blood products in resuscitation using fixed component transfusion ratios. This review also updates the evidence previously published in other systematic reviews . In addition, this is the first review assessing transfusion ratios of FFP and PLT in trauma patients exclusively and to use the GRADE profile to assess the evidence in trauma patients.…”

Section: Discussionsupporting

confidence: 52%

Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta‐analyses

et al. 2019

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BACKGROUNDDeaths by exsanguination in trauma are preventable with hemorrhage control and resuscitation with allogeneic blood products (ABPs). The ideal transfusion ratio is unknown. We compared efficacy and safety of high transfusion ratios of FFP:RBC and PLT:RBC with low ratios in trauma.STUDY DESIGN AND METHODSMedline, Embase, Cochrane, and Controlled Clinical Trials Register were searched. Observational and randomized data were included. Risk of bias was assessed using validated tools. Primary outcome was 24‐h and 30‐day mortality. Secondary outcomes were exposure to ABPs and improvement of coagulopathy. Meta‐analysis was conducted using a random‐effects model. Strength and evidence quality were graded using GRADE profileRESULTS55 studies were included (2 randomized and 53 observational), with low and moderate risk of bias, respectively, and overall low evidence quality. The two RCTs showed no mortality difference (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.40‐4.59). Observational studies reported lower mortality in high FFP:RBCs ratio (OR, 0.38 [95% CI, 0.22‐0.68] for 1:1 vs. <1:1; OR, 0.42 [95% CI, 0.22‐0.81] for 1:1.5 vs. <1:1.5; and OR, 0.47 [95% CI, 0.31‐0.71] for 1:2 vs. <1:2, respectively). Meta‐analyses in observational studies showed no difference in exposure to ABPs. No data on coagulopathy for meta‐analysis was identified.CONCLUSIONSMeta‐analyses in observational studies suggest survival benefit and no difference in exposure to ABPs. No survival benefit in RCTs was identified. These conflicting results should be interpreted with caution. Studies are mostly observational, with relatively small sample sizes, nonrandom treatment allocation, and high potential for confounding. Further research is warranted.

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Section: Discussionsupporting

confidence: 52%

Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta‐analyses

et al. 2019

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“…The goal of the present study was to use a large French multicenter prospective trauma registry to evaluate the association of an early (ie, first 6 hours), high FFP-to-PRBC transfusion ratio (ie, a mean of >2 FFP to 3 PRBC 33 ) with 30-day survival in patients with severe bleeding after trauma while accounting for confounders.…”

Section: Introductionmentioning

confidence: 99%

Association of Early, High Plasma-to–Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma

et al. 2019

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Key PointsQuestionIs an early, high transfusion ratio of fresh frozen plasma to packed red blood cells associated with 30-day mortality in patients with severe bleeding after trauma?FindingsIn this cohort study of 897 patients in the French national trauma registry Traumabase, an early, high transfusion ratio of fresh frozen plasma to packed red blood cells was associated with increased 30-day mortality in patients with severe bleeding after trauma.MeaningThese results support an early, high transfusion ratio of fresh frozen plasma to packed red blood cells as part of the hemostatic resuscitation strategy in severe trauma.

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“…The benefits associated with this approach have been evaluated in different clinical settings, including adult trauma patients, adult cardiac surgery patients, patients undergoing nontrauma massive transfusion and patients with ruptured abdominal aortic aneurysms . Furthermore, a recent meta‐analysis evaluating the benefits of a balanced transfusion ratio in trauma and surgical patients concluded that high plasma to red blood cell transfusion ratio was associated with improved survival at 24 h and 30 days mortality . However, this approach cannot be generalized to all bleeding patients needing transfusion.…”

Section: Introductionmentioning

confidence: 99%

A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization

et al. 2018

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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

Abstract: High FFP:RBC ratio confers survival benefits in trauma and non-trauma settings, with the highest survival benefit at 1:1.5.

Cited by 26 publications

References 44 publications

Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta‐analyses

Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta‐analyses

Association of Early, High Plasma-to–Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma

A high plasma: red blood cell transfusion ratio during liver transplantation is associated with decreased blood utilization

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