A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study

被引:287
作者
Zink, Karen A. [1 ]
Sambasivan, Chitra N. [1 ]
Holcomb, John B. [1 ]
Chisholm, Gary [1 ]
Schreiber, Martin A. [1 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Surg, Trauma Crit Care Sect, Portland, OR 97239 USA
关键词
Traumatic hemorrhage; Hemorrhagic shock; Massive transfusion; Transfusion ratios; Coagulopathy of trauma; DAMAGE CONTROL RESUSCITATION; FRESH-FROZEN PLASMA; EARLY COAGULOPATHY; TRAUMA CENTER; MORTALITY; HEMORRHAGE; SURVIVAL; PRODUCTS; DEATH;
D O I
10.1016/j.amjsurg.2008.12.014
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: In trauma. most hemorrhagic deaths occur within the first 6 hours. This study examined the effect on survival of high ratios of fresh frozen plasma (FFP) and platelets (PLTs) to packed red blood cells (PRBCs) in the first 6 hours. METHODS: Records of 466 massive transfusion trauma patients (>= 10 U of PRBCs in 24 hours) at 16 level I trauma centers were reviewed. Transfusion ratios in the first 6 hours were correlated with outcome. RESULTS: All groups had similar baseline characteristics. Higher 6-hour ratios Of FFP:PRBCs and PLTs:PRBCs lead to improved 6-hour mortality (from 37.3 [in the lowest ratio group] to 15.7 [in the middle ratio group] to 2.0% [in the highest ratio group] and 22.8% to 19.0% to 3.2%, respectively) and in-hospital mortality (from 54.9 to 41.1 to 25.5% and 43.7% to 46.8% to 27.4%, respectively). Initial higher ratios of FFP:PRBCs and PLTs:PRBCs decreased overall PRBC transfusion. CONCLUSIONS: The early administration of high ratios of FFP and platelets improves Survival and decreases overall PRBC need in massively transfused patients. The largest difference in mortality occurs during the first 6 hours after admission, suggesting that the early administration of FFP and platelets is critical. (C) 2009 Elsevier Inc. All rights reserved.
引用
收藏
页码:565 / 570
页数:6
相关论文
共 18 条
[1]  
American College of Surgeons, 1997, ADV TRAUM LIF SUPP D
[2]   The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital [J].
Borgman, Matthew A. ;
Spinella, Philip C. ;
Perkins, Jeremy G. ;
Grathwohl, Kurt W. ;
Repine, Thomas ;
Beekley, Alec C. ;
Sebesta, James ;
Jenkins, Donald ;
Wade, Charles E. ;
Holcomb, John B. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (04) :805-813
[3]   Acute traumatic coagulopathy [J].
Brohi, K ;
Singh, J ;
Heron, M ;
Coats, T .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (06) :1127-1130
[4]   Improved survival following massive transfusion in patients who have undergone trauma [J].
Cinat, ME ;
Wallace, WC ;
Nastanski, F ;
West, J ;
Sloan, S ;
Ocariz, J ;
Wilson, SE .
ARCHIVES OF SURGERY, 1999, 134 (09) :964-968
[5]   Fresh frozen plasma should be given earlier to patients requiring massive transfusion [J].
Gonzalez, Ernest A. ;
Moore, Frederick A. ;
Holcomb, John B. ;
Miller, Charles C. ;
Kozar, Rosemary A. ;
Todd, S. Rob ;
Cocanour, Christine S. ;
Balldin, Bjorn C. ;
McKinley, Bruce A. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 62 (01) :112-119
[6]   Damage control resuscitation: the need for specific blood products to treat the coagulopathy of trauma [J].
Hess, JR ;
Holcomb, JB ;
Hoyt, DB .
TRANSFUSION, 2006, 46 (05) :685-686
[7]   Minimizing dilutional coagulopathy in exsanguinating hemorrhage: A computer simulation [J].
Hirshberg, A ;
Dugas, M ;
Banez, EI ;
Scott, BG ;
Wall, MJ ;
Mattox, KL .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (03) :454-463
[8]   Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients [J].
Holcomb, John B. ;
Wade, Charles E. ;
Michalek, Joel E. ;
Chisholm, Gary B. ;
Zarzabal, Lee Ann ;
Schreiber, Martin A. ;
Gonzalez, Ernest A. ;
Pomper, Gregory. J. ;
Perkins, Jeremy G. ;
Spinella, Phillip C. ;
Williams, Kari L. ;
Park, Myung S. .
ANNALS OF SURGERY, 2008, 248 (03) :447-456
[9]   Causes of death in US Special Operations Forces in the global war on terrorism - 2001-2004 [J].
Holcomb, John B. ;
McMullin, Neil R. ;
Pearse, Lisa ;
Caruso, Jim ;
Wade, Charles E. ;
Oetyen-Gerdes, Lynne ;
Champion, Howard R. ;
Lawnick, Mimi ;
Farr, Warner ;
Rodriguez, Sam ;
Butler, Frank K. .
ANNALS OF SURGERY, 2007, 245 (06) :986-991
[10]   Damage control resuscitation: Directly addressing the early coagulopathy of trauma - Commentary [J].
Holcomb, John B. ;
Jenkins, Don ;
Rhee, Peter ;
Johannigman, Jay ;
Mahoney, Peter ;
Mehta, Sumeru ;
Cox, E. Darrin ;
Gehrke, Michael J. ;
Beilman, Greg J. ;
Schreiber, Martin ;
Flaherty, Stephen F. ;
Grathwohl, Kurt W. ;
Spinella, Phillip C. ;
Perkins, Jeremy G. ;
Beekley, Alec C. ;
McMullin, Neil R. ;
Park, Myung S. ;
Gonzalez, Ernest A. ;
Wade, Charles E. ;
Dubick, Michael A. ;
Schwab, William ;
Moore, Fred A. ;
Champion, Howard R. ;
Hoyt, David B. ;
Hess, John R. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 62 (02) :307-310