Impact of Plasma Transfusion in Massively Transfused Trauma Patients

Teixeira, Pedro G.R.; Inaba, Kenji; Shulman, Ira A.; Salim, Ali; Δημητριάδης, Δημήτριος; Brown, Carlos; Browder, Timothy; Green, Donald P.; Rhee, Peter

doi:10.1097/ta.0b013e31817e5c77

Cited by 161 publications

(110 citation statements)

References 12 publications

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“…In his retrospective analysis of multiple level 1 trauma centers he found that a FFP:pRBC ratio greater than 1:2 was associated with significantly lower thirty-day mortality in patients who were severely injured (mean ISS 32) and received a mass transfusion. Other investigators have corroborated these findings with even higher FFP:pRBC ratios [64][65][66], while another was able to demonstrate an early survival benefit with a balanced approach regardless of admission coagulopathy [67]. When investigators looked at trauma patients who received a sub-massive transfusion the results became more complicated.…”

Section: Blood Productssupporting

confidence: 60%

Volume Management and Resuscitation in Trauma

Bradley

Nelson

2014

Curr Anesthesiol Rep

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Trauma remains an enormous burden on the American medical system. While patients of all ages sustain severe trauma, it remains the most common cause of death in young adults. Exsanguination from uncontrolled hemorrhage is the leading cause of preventable death among the traumatically injured. The lethal triad of trauma is a culmination of coagulopathy, acidosis, and hypothermia that can rapidly deteriorate and lead to a patient's demise if not treated accordingly. The goal of trauma resuscitation is to prevent or halt this triad while minimizing iatrogenic injury. The provider has many options available in his armamentarium for resuscitation, but each carries its own risks and benefits. Over the past two decades, trauma research has given us a better understanding of and improved management strategies for this triad. This chapter will explore the various resuscitative options available and summarize the most recent literature regarding their use.

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Section: Blood Productssupporting

confidence: 60%

Volume Management and Resuscitation in Trauma

Bradley

Nelson

2014

Curr Anesthesiol Rep

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“…22 This area of debate is likely to continue until a prospective randomized trial is completed. 1,[4][5][6][7]9 Although the technique of perihepatic packing was founded in 1908 with Pringle's discussion of hepatic trauma, 43 the modern interpretation of this work occurred in the late 1970s, [44][45][46] followed by the concept of truncated operations with concurrent intra-abdominal packing for patients in physiologic extremis by Stone and colleagues in 1983. 47 This philosophy was then coined "damage control" by Rotondo and colleagues, given its obvious conceptual similarity to the Navy's use of the same term.…”

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.…”

mentioning

confidence: 99%

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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“…However, it is currently also practiced in the civilian area. In a retrospective study of massively transfused civilian patients, Teixeira et al [89] noted a significant reduction in mortality in those patients where FFP was transfused more aggressively. The improvement reached a plateau-like maximum at a relation of 1:3.…”

Section: Plateletsmentioning

confidence: 99%

Massive Bleeding and Massive Transfusion

Meißner¹,

Schlenke

2012

Transfus Med Hemother

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Massive bleeding in trauma patients is a serious challenge for all clinicians, and an interdisciplinary diagnostic and therapeutic approach is warranted within a limited time frame. Massive transfusion usually is defined as the transfusion of more than 10 units of packed red blood cells (RBCs) within 24 h or a corresponding blood loss of more than 1- to 1.5-fold of the body’s entire blood volume. Especially male trauma patients experience this life-threatening condition within their productive years of life. An important parameter for clinical outcome is to succeed in stopping the bleeding preferentially within the first 12 h of hospital admission. Additional coagulopathy in the initial phase is induced by trauma itself and aggravated by consumption and dilution of clotting factors. Although different aspects have to be taken into consideration when viewing at bleedings induced by trauma compared to those caused by major surgery, the basic strategy is similar. Here, we will focus on trauma-induced massive hemorrhage. Currently there are no definite, worldwide accepted algorithms for blood transfusion and strategies for optimal coagulation management. There is increasing evidence that a higher ratio of plasma and RBCs (e.g. 1:1) endorsed by platelet transfusion might result in a superior survival of patients at risk for trauma-induced coagulopathy. Several strategies have been evolved in the military environment, although not all strategies should be transferred unproven to civilian practice, e.g. the transfusion of whole blood. Several agents have been proposed to support the restoration of coagulation. Some have been used for years without any doubt on their benefit-to-risk profile, whereas great enthusiasm of other products has been discouraged by inefficacy in terms of blood transfusion requirements and mortality or significant severe side effects. This review surveys current literature on fluid resuscitation, blood transfusion, and hemostatic agents currently used during massive hemorrhage in order to optimize patients’ blood and coagulation management in emergency medical aid.

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Impact of Plasma Transfusion in Massively Transfused Trauma Patients

Abstract: Higher FFP:PRBC ratio is an independent predictor of survival in massively transfused patients. Aggressive early use of FFP may improve outcome in massively transfused trauma patients.

Cited by 161 publications

References 12 publications

Volume Management and Resuscitation in Trauma

Volume Management and Resuscitation in Trauma

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

Massive Bleeding and Massive Transfusion

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