The Ratio of Fibrinogen to Red Cells Transfused Affects Survival in Casualties Receiving Massive Transfusions at an Army Combat Support Hospital

Abstract

In patients with combat-related trauma requiring massive transfusion, the transfusion of an increased fibrinogen: RBC ratio was independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage. Prospective studies are needed to evaluate the best source of fibrinogen and the optimal empiric ratio of fibrinogen to RBCs in patients requiring massive transfusion.

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

“…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.…”

Fibrinogen Availability and Coagulation Function after Hemorrhage and Resuscitation in Pigs

“…To observe the effects of fibrinogen on survival, Stinger et al performed a retrospective analysis in massive transfused trauma patients at a United States Army combat support hospital and reported that the amount of fibrinogen administered from transfused blood products correlates with survival (5). The mortality rates in patients receiving high amounts of fibrinogen (≥0.2 g from transfused blood products per unit red blood cells) and low amounts of fibrinogen (<0.2 g) were 24% and 52%, respectively (P < 0.001) (5). In central Europe, fibrinogen concentrates and prothrombin complex concentrate (PCC) have been used to treat acquired bleeding complications in surgical and trauma patients with success (6)(7)(8)(9)(10).…”

Emerging treatment strategies for trauma-induced coagulopathy (Br J Surg 2012; 99(Suppl 1): 40–50)

“…Data on the efficacy of fibrinogen concentrates in acquired fibrinogen deficiency are limited. In vitro studies and experimental investigations 58 -63 , as well as reports from postmarketing surveillance and retrospective data analyses, have shown consistently that fibrinogen can increase clot firmness and improve survival of severely injured massively bleeding patients/soldiers 64 . Four small prospective clinical studies examined the use of fibrinogen concentrate (ROTEM  -assisted in two studies).…”