The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis

Transfusion ratios approaching 1:1 FFP:PRBC for trauma resuscitation have become the de facto standard of care. The aim of this study was to prospectively evaluate the effect of increasing ratios of FFP:PRBC transfusion on survival for massively transfused civilian trauma patients as well as determine if time to reach the target ratio had any effect on outcomes. This is a prospective, observational study of all trauma patients requiring a massive transfusion (a parts per thousand yen10 PRBC in a parts per thousand currency sign24 h) at a level 1 trauma center over a 2.5-year period. The ratio of FFP:PRBC was tracked hourly up to 24 h post-initiation of massive transfusion. A logistic regression model was utilized to identify the ideal ratio associated with mortality prediction. A stepwise logistic regression was performed to identify independent predictors of mortality. The study population was predominantly male (89 %) with a mean age of 34.8 +/- 16. On admission, 22 % had a systolic blood pressure a parts per thousand currency sign90 mmHg, 47 % had a heart rate a parts per thousand yen120, and 25 % had a GCS a parts per thousand currency sign8. The overall mortality was 33 %. The ratio of FFP:PRBC a parts per thousand yen 1:1.5 was the second most important independent predictor of mortality for this population (R (2) = 0.59). Survivors had a higher FFP:PRBC ratio at all times during the first 24 h of resuscitation. Achieving a ratio of FFP:PRBC a parts per thousand yen 1:1.5 after the initial 24 h of resuscitation significantly improves survival in massively transfused trauma patients compared to patients that achieved a ratio < 1:1.5.