OBJECTIVES: Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy. METHODS: Prospective data were collected on 806 consecutive trauma patients admitted to the intensive care unit over 2 years. Patients were stratified by PRBC:FFP transfusion ratio over the first 24 hours. Stepwise regression models were performed controlling for age, gender, mechanism of injury, injury severity, and acute physiology and chronic health evaluation (APACHE) 2 score to determine if early aggressive use of PRBC:FFP improved outcome. RESULTS: Seventy-seven percent of patients were male (N = 617) and 85% sustained blunt injury (n = 680). Mean age, injury severity score (ISS), and APACHE score were 43 +/- 20 years, 29 +/- 13, and 13 +/- 7, respectively. Mean number of PRBCs and FFP transfused were 7.7 +/- 12 U, 6 U, and 5 +/- 12 U, respectively. Three hundred sixty-five (45%) patients were transfused in the first 24 hours. Sixty-eight percent (n = 250) of them received both PRBCs and FFP. Analyzing these patients by stepwise regression controlling for all significant variables, the PRBC:FFP ratio did not predict intensive care unit days, hospital days, or mortality even in patients who received massive transfusion (> or = 10 U). Furthermore, there was no significant difference in outcome when comparing patients who had a 1:1 PRBC:FFP ratio with those who did not receive any FFP. CONCLUSION: Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.
OBJECTIVES: Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy. METHODS: Prospective data were collected on 806 consecutive traumapatients admitted to the intensive care unit over 2 years. Patients were stratified by PRBC:FFP transfusion ratio over the first 24 hours. Stepwise regression models were performed controlling for age, gender, mechanism of injury, injury severity, and acute physiology and chronic health evaluation (APACHE) 2 score to determine if early aggressive use of PRBC:FFP improved outcome. RESULTS: Seventy-seven percent of patients were male (N = 617) and 85% sustained blunt injury (n = 680). Mean age, injury severity score (ISS), and APACHE score were 43 +/- 20 years, 29 +/- 13, and 13 +/- 7, respectively. Mean number of PRBCs and FFP transfused were 7.7 +/- 12 U, 6 U, and 5 +/- 12 U, respectively. Three hundred sixty-five (45%) patients were transfused in the first 24 hours. Sixty-eight percent (n = 250) of them received both PRBCs and FFP. Analyzing these patients by stepwise regression controlling for all significant variables, the PRBC:FFP ratio did not predict intensive care unit days, hospital days, or mortality even in patients who received massive transfusion (> or = 10 U). Furthermore, there was no significant difference in outcome when comparing patients who had a 1:1 PRBC:FFP ratio with those who did not receive any FFP. CONCLUSION: Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.
Authors: Phillip A Letourneau; Madonna McManus; Kendell Sowards; Weiwei Wang; Yao-wei Wang; Nena Matijevic; Shibani Pati; Charles E Wade; John B Holcomb Journal: J Trauma Date: 2011-11
Authors: E Bui; K Inaba; A Ebadat; E Karamanos; S Byerly; O Okoye; I Shulman; P Rhee; D Demetriades Journal: Eur J Trauma Emerg Surg Date: 2015-09-11 Impact factor: 3.693
Authors: John B Holcomb; Barbara C Tilley; Sarah Baraniuk; Erin E Fox; Charles E Wade; Jeanette M Podbielski; Deborah J del Junco; Karen J Brasel; Eileen M Bulger; Rachael A Callcut; Mitchell Jay Cohen; Bryan A Cotton; Timothy C Fabian; Kenji Inaba; Jeffrey D Kerby; Peter Muskat; Terence O'Keeffe; Sandro Rizoli; Bryce R H Robinson; Thomas M Scalea; Martin A Schreiber; Deborah M Stein; Jordan A Weinberg; Jeannie L Callum; John R Hess; Nena Matijevic; Christopher N Miller; Jean-Francois Pittet; David B Hoyt; Gail D Pearson; Brian Leroux; Gerald van Belle Journal: JAMA Date: 2015-02-03 Impact factor: 56.272
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