Application of damage control resuscitation strategies to patients with severe traumatic hemorrhage: review of plasma to packed red blood cell ratios at a single institution.

Abstract

When treating trauma patients with severe hemorrhage, massive transfusions are

often needed. Damage control resuscitation strategies can be used for such

patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC)

administration ratio must be established. We retrospectively reviewed the medical

records of 100 trauma patients treated with massive transfusions from March 2010

to October 2012. We divided the patients into 2 groups according to the FFP:PRBC

ratio: a high-ratio (>/=0.5) and a low-ratio group (<0.5). The patient

demographics, fluid and transfusion quantities, laboratory values, complications,

and outcomes were analyzed and compared. There were 68 patients in the high-ratio

and 32 in the low-ratio group. There were statistically significant differences

between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids

administered, as well as the initial diastolic blood pressure. Bloodstream

infections were noted only in the high-ratio group, and the difference was

statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr

survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%,

P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or

higher may increase the chances of survival. Efforts to minimize bloodstream

infections during the resuscitation must be increased.