Effect of Plasma-to-RBC Ratios in Trauma Patients

Halmin, Märit; Boström, Fredrik; Brattström, Olof; Lundahl, Joachim; Wikman, Agneta; Östlund, Anders; Edgren, Gustaf

doi:10.1097/ccm.0b013e31828a3214

Cited by 35 publications

(22 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25–28 Ratios averaged over 6 hours, the shortest time interval in this data set, did not change over time, and were not associated with MOF. However, these ratios should be calculated within shorter time intervals to avoid masking “catch-up” practices and to account for time-varying ratios.…”

Section: Discussionmentioning

confidence: 72%

Temporal trends of postinjury multiple-organ failure

Sauaia

Moore

Johnson

et al. 2014

Journal of Trauma and Acute Care Surgery

141

109

View full text Add to dashboard Cite

BACKGROUND While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolving epidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols. METHODS “Inflammation and Host Response to Injury Collaborative Program” institutions that enrolled more than 20 eligible patients per biennial during the 2003 to 2010 study period were included. The patients were aged 16 years to 90 years, sustained blunt torso trauma with hemorrhagic shock (systolic blood pressure < 90 mm Hg, base deficit ≥ 6 mEq/L, blood transfusion within the first 12 hours), but without severe head injury (motor Glasgow Coma Scale [GCS] score < 4). MOF temporal trends (Denver MOF score > 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis. RESULTS A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003–2004 to 9.8% in 2009–2010). MOF-related death rate (33% in 2003–2004 to 36% in 2009–2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%). CONCLUSION Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy. LEVEL OF EVIDENCE Epidemiologic study, level III.

show abstract

Section: Discussionmentioning

confidence: 72%

Temporal trends of postinjury multiple-organ failure

Sauaia

Moore

Johnson

et al. 2014

Journal of Trauma and Acute Care Surgery

141

109

View full text Add to dashboard Cite

show abstract

“…The available information is highly valid for descriptive analyses and information of general patterns, but we have chosen to not perform more detailed analyses regarding, for example, blood component ratios and survival, since such analyses require access to more detailed data on important confounders and transfusion data with better temporal resolution (16). In line with our purpose, we also chose a relatively broad classification of indications that could provide information on general characteristics without being prone to misclassification or biased results.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Massive Transfusion

Halmin

Chiesa

Vasan

et al. 2016

Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.

show abstract

“…Plasma has demonstrated superiority over colloid fluids at reversing coagulopathy secondary to trauma and improving survival in animal models, even in the absence of transfused RBCs (33,34). Although earlier studies concerning plasma-to-RBC ratios probably suffer from some degree of survival bias (resulting from early death occurring after administration of RBCs but before administration of plasma) (39), several recent studies that were designed to address this bias also demonstrate the benefits of early plasma transfusion (28,40,41). In addition, it was established that earlier administration of plasma is associated with improved survival, an effect that diminished with delayed infusion (8,28,37,38).…”

Section: Plasma As the Primary Resuscitation Fluid In Military Prehosmentioning

confidence: 99%

“…Prehospital data may also have the benefit of being less affected by the well-described survival bias associated with transfusion ratios in the hospital settings (39). All data concerning FDP administration, both clinical and operational, are collected in the form of mandatory after-action reports, which are then recorded and analyzed using the IDF trauma registry as part of an ongoing effort to learn and improve combat casualty care.…”

Section: The Way Aheadmentioning

confidence: 99%

Freeze-Dried Plasma at the Point of Injury

Glassberg¹,

Nadler²,

Gendler³

et al. 2013

Shock

View full text Add to dashboard Cite

While early plasma transfusion for the treatment of patients with ongoing major hemorrhage is widely accepted as part of the standard of care in the hospital setting, logistic constraints have limited its use in the out-of-hospital setting. Freeze-dried plasma (FDP), which can be stored at ambient temperatures, enables early treatment in the out-of-hospital setting. Point-of-injury plasma transfusion entails several significant advantages over currently used resuscitation fluids, including the avoidance of dilutional coagulopathy, by minimizing the need for crystalloid infusion, beneficial effects on endothelial function, physiological pH level, and better maintenance of intravascular volume compared with crystalloid-based solutions. The Israel Defense Forces Medical Corps policy is that plasma is the resuscitation fluid of choice for selected, severely wounded patients and has thus included FDP as part of its armamentarium for use at the point of injury by advanced life savers, across the entire military. We describe the clinical rationale behind the use of FDP at the point-of-injury, the drafting of the administration protocol now being used by Israel Defense Forces advanced life support providers, the process of procurement and distribution, and preliminary data describing the first casualties treated with FDP at the point of injury. It is our hope that others will be able to learn from our experience, thus improving trauma casualty care around the world.

show abstract

Effect of Plasma-to-RBC Ratios in Trauma Patients

Cited by 35 publications

References 30 publications

Temporal trends of postinjury multiple-organ failure

Temporal trends of postinjury multiple-organ failure

Epidemiology of Massive Transfusion

Freeze-Dried Plasma at the Point of Injury

Contact Info

Product

Resources

About