The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital

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

“…Previous studies have indicated that an increased ratio of FFP:RBC for patients requiring massive transfusion was independently associated with survival. 7 Our results indicate that the amount of plasma transfused is independently associated with improved survival for patients with traumatic injuries requiring any amount of blood products.…”

“…37 Recent studies suggest that fibrinogen administration is essential for achieving hemostasis in patients with significant traumatic injuries [43][44][45][46][47][48] and very likely contributes to the improved outcomes that have been associated with increased transfusion of plasma. 7,49,50 However, the use of plasma as a volume expander is controversial though this practice has been relatively abandoned since the 1940s. 33 Volume expansion for hypovolemic patients in hemorrhagic shock is required to improve cardiac output by maintaining preload.…”

“…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.…”

“…[3][4][5][6] Strategies or therapeutic principles that can be rapidly applied have the potential to prevent death from hemorrhagic shock and have a significant impact on improving survival for patients with traumatic injuries. 7,8 According to Advanced Trauma Life Support guidelines, the standard approach to the resuscitation of patients with hemorrhagic shock includes the initial bolus of 2 L of crystalloid solutions and then red blood cell (RBC) transfusion. 9 Plasma products are transfused based on the laboratory documentation of coagulopathy.…”

Instrument fails, but surgeon should not. Easy approaches for retrieval of broken intramedullary reamer from the tibia

“…In severe hemorrhage cases, massive transfusions of up to 10-15 units are often required. For example, during 5 years of US military operations, about 86,000 units of RBC and whole blood (WB) were administered to about 5,000 patients (1,2). While the benefit of transfusion for severe hemorrhage cases is well accepted, multiple studies suggest that RBC transfusions nevertheless can fall short of achieving their desired clinical effect -particularly for certain vulnerable patient groups -prompting reexamination of transfusion protocols and the preserved efficacy of stored packed RBC (see (3)(4)(5)(6)(7)(8) for reviews).…”