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Changes in massive transfusion over time: an early shift in the right direction?
Benjamin C Kautza1, Mitchell J Cohen, Joseph Cuschieri
1Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
The Journal of Trauma and Acute Care Surgery
|February 8, 2012
Summary
Higher ratios of fresh frozen plasma (FFP) and platelet (PLT) transfusions to packed red blood cells (PRBCs) were observed in patients not requiring massive transfusion (MT). This suggests early aggressive transfusion strategies may reduce MT incidence.
Area of Science:
- Trauma resuscitation
- Massive transfusion protocols
- Hemorrhagic shock management
Background:
- High fresh frozen plasma:packed red blood cell (FFP:PRBC) and platelet:PRBC (PLT:PRBC) transfusion ratios may mitigate coagulopathy in massive transfusion (MT).
- Changes in resuscitation practices over time for severely injured patients requiring MT were evaluated.
Purpose of the Study:
- To characterize temporal changes in transfusion practices for severely injured patients requiring MT.
- To analyze shifts in FFP:PRBC and PLT:PRBC ratios and overall transfusion volumes over time.
Main Methods:
- A multicenter prospective cohort study of blunt injured adults in hemorrhagic shock.
- Massive transfusion (MT) defined as ≥10 units PRBCs within 24 hours.
- Analysis of transfusion requirements (PRBC, FFP, PLT) at 6, 12, and 24 hours, comparing 'early' (pre-2007) and 'recent' (post-2007) periods.
Main Results:
- Overall MT incidence decreased over time; Injury Severity Score increased.
- No significant temporal changes in FFP:PRBC or PLT:PRBC ratios were observed in the MT group.
- Sub-MT patients (≥7 to <10 PRBC units) showed higher recent FFP:PRBC and PLT:PRBC ratios, with a greater percentage of total transfusion occurring within 6 hours.
Conclusions:
- While MT rates decreased, transfusion ratios in MT patients remained constant.
- Earlier and more aggressive use of FFP and PLT in sub-MT patients suggests a potential strategy to reduce MT.
- Further prospective studies are needed to confirm if early high transfusion ratios can decrease MT requirements.
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