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Updated: Jun 24, 2026
Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
Published on: June 6, 2011
Where does cryoprecipitate fit into balanced resuscitation? An evaluation of 2,117 hemorrhaging patients using
Jan-Michael Van Gent1, Thomas W Clements, Jennifer M Gurney
1From the Department of Surgery (J.-M.V.G., T.W.C., B.A.C.), McGovern Medical School, University of Texas Health Science Center, Houston; and Joint Trauma System (J.-M.V.G., J.M.G.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas.
Background:
Empiric cryoprecipitate administration has recently failed to show survival benefit in hemorrhaging trauma patients. However, a recent Trauma Quality Improvement Program query suggested a survival benefit in massive transfusions when administering 1 U of cryoprecipitate to every 7 to 8 U of red blood cells (RBCs). We describe transfusion ratios when cryoprecipitate was indicated by viscoelastic testing (VET) and evaluated whole blood (WB)'s impact on this ratio.
Methods:
Adult trauma patients admitted from July 2017 to December 2021 who received emergency-release blood products prehospital or in the emergency department were included. Patients who died within 60 minutes were excluded. Massive transfusion patients received arrival VET, which was repeated serially while on massive transfusion protocol. Cryoprecipitate transfusion was based on VET results. Blood product ratios were calculated for RBC, plasma, platelets, and cryoprecipitate in the first four and 24 hours of resuscitation. Each WB unit was counted as 1 RBC, 1 plasma, and 0.17 U of platelets. Outcomes were evaluated based on blood component ratios. Patients receiving WB were compared with patients who only received blood components.
Results:
A total of 2,117 patients were included. Overall, the median age was 37 (25, 55) years, 74% were male, 37% were white, and 67% sustained blunt trauma. Overall survival was 77%. The median 4-hour RBC/plasma/platelet/cryoprecipitate ratio was 9:9.5:1.3:1. Patients who received WB did not require cryoprecipitate until later in their resuscitation when compared with blood components (10:9.5:1.7:1 vs. 7:6:1:1, p = 0.008).
Conclusion:
When using routine VET to guide resuscitation for hemorrhage, cryoprecipitate transfusion occurred later in patients receiving WB incorporated resuscitations compared with the component only strategy. For centers that do not use VET and use algorithmic resuscitation protocols, cryoprecipitate transfusion should be considered after 7 U of RBCs/plasma and after 10 U of a WB incorporated resuscitation.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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