Early Aggressive Use of Fresh Frozen Plasma Does Not Improve Outcome in Critically Injured Trauma Patients

Scalea, Thomas M.; Bochicchio, Kelly; Lumpkins, Kimberly; Hess, John R.; Dutton, Richard P.; Pyle, Anne; Bochicchio, Grant V.

doi:10.1097/sla.0b013e31818990ed

Cited by 208 publications

(151 citation statements)

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“…This lack of reduction in mortality despite the 1:1:1 massive transfusion has been previously described in mixed cohorts of injured patients. 21,24 It remains consistent when the mortality bias is corrected, 23 despite a clear improvement in early coagulopathy. 22 This area of debate is likely to continue until a prospective randomized trial is completed.…”

Section: Discussionmentioning

confidence: 79%

“…1,[21][22][23][24] Prior to the implementation of a formalized high plasma MTP (Table 1), mortality for patients who required a massive transfusion (≥ 10 units of RBCs) following grade 3, 4 or 5 hepatic injuries at our institution was 60%, 46% and 71%, respectively. Given associated patient ISS of 31, 26 and 29, Total PRBC units, < 6 h 28 20…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] While the effect on overall mortality in the civilian population is still debated, [21][22][23][24] massive resuscitations with high plasma:packed red blood cell (RBC) ratios remain promising for addressing the early coagulopathy 25 and acidosis frequently associated with life-threatening injury. 10 Additional benefits of a formal MTP include earlier administration of blood products during the resuscitation phase, improved overall efficiency, decreased total blood product use during a patient's hospital stay and a substantial economic savings.…”

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confidence: 99%

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The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

et al. 2013

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Background: Massive transfusion protocols (MTPs) using high plasma and platelet ratios for exsanguinating trauma patients are increasingly popular. Major liver injuries often require massive resuscitations and immediate hemorrhage control. Current published literature describes outcomes among patients with mixed patterns of injury. We sought to identify the effects of an MTP on patients with major liver trauma.Methods: Patients with grade 3, 4 or 5 liver injuries who required a massive blood component transfusion were analyzed. We compared patients with high plasma:red blood cell:platelet ratio (1:1:1) transfusions (2007)(2008)(2009)) with patients injured before the creation of an institutional MTP (2005MTP ( -2007.Results: Among 60 patients with major hepatic injuries, 35 (58%) underwent resuscitation after the implementation of an MTP. Patient and injury characteristics were similar between cohorts. Implementation of the MTP significantly improved plasma: red blood cell:platelet ratios and decreased crystalloid fluid resuscitation (p = 0.026). Rapid improvement in early acidosis and coagulopathy was superior with an MTP (p = 0.009). More patients in the MTP group also underwent primary abdominal fascial closure during their hospital stay (p = 0.021). This was most evident with grade 4 injuries (89% vs. 14%). The mean time to fascial closure was 4.2 days. The overall survival rate for all major liver injuries was not affected by an MTP (p = 0.61). Conclusion:The implementation of a formal MTP using high plasma and platelet ratios resulted in a substantial increase in abdominal wall approximation. This occurred concurrently to a decrease in the delivered volume of crystalloid fluid.Contexte : Les protocoles de transfusion massive (PTM) impliquant des rapports plasma:plaquettes élevés sont de plus en plus populaires pour traiter les patients atteints d'un traumatisme hémorragique. Les chirurgies majeures du foie requièrent souvent le déclenchement de protocoles de transfusion massive et une maîtrise immé-diate de l'hémorragie. La littérature actuelle décrit les résultats chez des patients victimes de divers types de traumatismes. Nous avons voulu mesurer les effets d'un PTM sur les patients ayant subi un traumatisme majeur au foie. Résultats : Sur 50 patients ayant subi des lésions hépatiques majeures, 35 (58 %) ont reçu des traitements de réanimation après la mise en place du PTM. Les caractéristiques propres aux patients et à leurs blessures étaient similaires entre les cohortes. L'application du PTM a significativement amélioré les rapports plasma:culots globulaires:plaquettes et réduit l'administration de cristalloïdes à des fins de réanimation liquidienne (p = 0,026). L'amélioration rapide de l'acidose naissante et de la coagulopathie a été meilleure avec le PTM (p = 0,009). Plus de patients du groupe soumis au PTM ont aussi subi une fermeture aponévrotique abdominale primaire durant leur séjour hospitalier (p = 0,021). Cela s'est surtout observé avec les lésions de grade 4 (89 % c. 14 %). Le délai moyen av...

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

et al. 2013

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“…One small prospective study failed to show improved outcome with a 1 : 1 ratio of FFP : PRBC [62]. It is noteworthy that in the German Registry study [56], the number of septic complications and incidence of MOF was higher in the group receiving 1 : 1 FFP :…”

Section: Massive Haemorrhage Protocolsmentioning

confidence: 99%

Resuscitation and coagulation in the severely injured trauma patient

Midwinter

Woolley

2011

Phil. Trans. R. Soc. B

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Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

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“…Fibrinogen is the first coagulation factor to fall below a critical value during massive bleeding and hemodilution 4. An increasing number of studies have reported the limited efficacy of fresh frozen plasma in treating severe hypofibrinogenemia 5. The fibrinogen level at admission is reported to be an independent predictor of mortality for trauma patients,6 and another study suggested that fibrinogen supplementation improves outcomes for traumatic hemorrhage 7…”

Section: Introductionmentioning

confidence: 99%

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

Inokuchi

Sawano

Yamamoto

et al. 2017

Acute Medicine & Surgery

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AimHemorrhage from pelvic fracture is a major cause of mortality after blunt trauma. Several studies have suggested that early fibrinogen supplementation improves outcomes of traumatic hemorrhage. Thus, we revised our massive transfusion protocol (MTP) in April 2013 to include early off‐label administration of fibrinogen concentrate. The objective of this study was to evaluate the impact of the revision on the short‐term outcomes of pelvic fracture patients.MethodsThis was a single‐center, retrospective, cohort study. A total of 224 consecutive pelvic fracture patients hospitalized in Saitama Medical Center (Saitama, Japan), 115 before the revision (Group E) and 109 after (Group L), were enrolled. Characteristics of the patients were compared between the groups. Impacts of the revision were evaluated by hazard ratios adjusted for characteristics, injury severity, and coagulation status using Cox's multivariate proportional hazard model. The impact was also evaluated by log–rank test and relative risk of 28‐day mortality between the groups.ResultsThe characteristics were equivalent between the groups. The multivariate analysis revealed that the revision of MTP was significantly related to improved survival with an adjusted hazard ratio (95% confidence interval) of 0.45 (0.07–0.97). The log–rank test gave χ2‐test values of 5.2 (P = 0.022) and 6.7 (P = 0.009), and the relative risks were 0.37 (0.15–0.91) and 0.33 (0.13–0.84), in patients with all Injury Severity Scores and Injury Severity Score ≥21, respectively.ConclusionThe revision of MTP to include aggressive off‐label treatment with fibrinogen concentrate was related to improved short‐term outcomes of severe pelvic fracture patients. However, due to the limitations of the study, the improvement could not be attributed totally to the revision.

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Early Aggressive Use of Fresh Frozen Plasma Does Not Improve Outcome in Critically Injured Trauma Patients

Abstract: Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.

Cited by 208 publications

References 23 publications

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

Resuscitation and coagulation in the severely injured trauma patient

Early administration of fibrinogen concentrates improves the short‐term outcomes of severe pelvic fracture patients

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