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

  • T.M. S
  • K.M. B
  • K. L
 et al. 
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Abstract

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

  • *blood component therapy
  • *fresh frozen plasma/ct [Clinical Trial]
  • *fresh frozen plasma/dt [Drug Therapy]
  • *injury/di [Diagnosis]
  • *injury/dt [Drug Therapy]
  • *injury/th [Therapy]
  • *intensive care
  • *plasma
  • *resuscitation
  • Iraq
  • adult
  • age distribution
  • article
  • blunt trauma/dt [Drug Therapy]
  • clinical trial
  • comparative study
  • controlled clinical trial
  • controlled study
  • critically ill patient
  • disease severity
  • emergency health service
  • erythrocyte concentrate
  • female
  • follow up
  • human
  • injury scale
  • intensive care unit
  • major clinical study
  • male
  • methodology
  • outcome assessment
  • priority journal
  • prospective study
  • sex difference
  • therapy effect
  • time
  • treatment outcome
  • treatment response

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Authors

  • Scalea T.M.

  • Bochicchio K.M.

  • Lumpkins K.

  • Hess J.R.

  • Dutton R.

  • Pyle A.

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