Optimal Plasma Transfusion in Patients Undergoing Cardiac Operations With Massive Transfusion

Observational studies suggest that transfusion of high ratios of fresh frozen plasma (FFP) to red blood cells (RBCs) reduces mortality in severe hemorrhage. There are no studies examining the impact of the FFP to RBC transfusion ratio on mortality in massively transfused patients undergoing cardiac operations.

A single-center retrospective cohort study was performed over an 8.5-year period. Massive transfusion was defined as at least 8 RBC units administered during the operation. Patients were classified as having received a high FFP/RBC ratio (greater than 1:1), a moderate ratio (between 1:1 and 1:2), or a low ratio (<1:2). Thirty-day survival was compared between groups using Kaplan-Meier analysis, and Cox proportional hazards modeling was used to identify variables associated with 30-day mortality. In-hospital mortality and postoperative morbidities were also compared between groups using regression analyses.

Of 7,492 patients undergoing cardiac operations, 452 (6%) were massively transfused. Thirty-day mortality was 25.4% and in-hospital mortality was 30.6%. Patients with a high transfusion ratio had improved 30-day survival when compared with those with a low ratio (hazard ratio [HR] for death, 0.339; p = 0.002). High transfusion ratios were also associated with fewer reoperations for bleeding, less renal failure, more prolonged ventilation, and more atrial fibrillation compared with low ratios.

A high transfusion ratio may improve survival in patients undergoing cardiac operations with massive intraoperative transfusion but may increase the risk for prolonged ventilation and atrial fibrillation.