Fresh Frozen Plasma Should be Given Earlier to Patients Requiring Massive Transfusion

Abstract

These data indicate acidosis and hypothermia to be well managed. Coagulopathy was not corrected in the ICU despite adherence to pre-ICU MT and ICU protocols, likely because of inadequate pre-ICU intervention. More aggressive pre-ICU intervention to correct coagulopathy may be effective in decreasing PRBC requirement during ICU resuscitation, and, because of the association with increased mortality, could improve outcome. We have revised our pre-ICU MT protocol to emphasize early FFP in a FFP:PRBC ratio of 1:1. We think that treatment of coagulopathy can be improved with the development of standardized protocols, both empiric and data driven.

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

“…24,65,66 A balanced approach of all blood components in a 1:1:1 ratio, with the use of RBCs less than 14 days of storage, may be the optimal empiric resuscitation approach for patients with hemorrhagic shock. 7,31,33,42,67,68 Increased plasma transfusion for patients bleeding with traumatic injuries may increase risks associated with its use. Significant risks associated with plasma use include transfusion related acute lung injury and nonhemolytic transfusion reactions.…”

Elevated international normalised ratios correlate with severity of injury and outcome

“…An INR >1.2 was considered indicative of coagulopathy, in accordance with previous studies. [16,17] Missing blood results in the first hour of admission were excluded from the study. The mechanism of injury was obtained from the patient's electronic chart.…”

Impact of Crystalloid to PRBC Ratio in Patients with Exsanguinating Penetrating Abdominal Injuries: The Conundrum of Resuscitation

“…Civilian and military studies have demonstrated a survival benefit when a close ratio resuscitation of fresh frozen plasma (FFP) to packed red blood cells (PRBC) is used in EPAI. [5][6][7][8][9] Resuscitation strategies in patients with EPAI have evolved throughout the years. Military resuscitation during 1960s used aggressive crystalloid resuscitation with no predefined transfusion ratio of blood component therapy.…”

“…This resuscitation strategy has been accepted by many civilian trauma centers with overall improvement in outcomes. [5][6][7][8][9][12][13][14] The etiology leading to this improvement could be multifactorial. During close ratio resuscitation, the goal should consist of FFP matched to PRBC in a 1:1 fashion while minimizing crystalloid utilization.…”