Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients.

  • Scalea T
  • Bochicchio K
  • Lumpkins K
 et al. 
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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.

Author-supplied keywords

  • Adult; Blood Component Transfusion
  • diagnosis/therapy
  • methods; Critical Care
  • methods; Female; Follow-Up Studies; Humans; Male;

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  • Thomas M Scalea

  • Kelly M Bochicchio

  • Kim Lumpkins

  • John R Hess

  • Richard Dutton

  • Anne Pyle

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