The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients

Purpose High ratios of Plasma to Packed Red Blood Cells (FFP:PRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy. Methods Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFP: PRBC ratio-cut-offs (1: 2 and 1: 3) and adjusted mortality derived. Results Over 8 years, 29 % (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFP: PRBC ratios (45 % for ratio = 1: 8, 33 % for ratio > 1: 8 and = 1: 3, 27 % for ratio > 1: 3 and = 1: 2 and 25 % for ratio > 1: 2). Increasing FFP: PRBC ratio independently predicted survival (AOR [95 % CI]: 1.91 [1.35-2.71]; p < 0.001). Patients achieving a ratio > 1: 3 had improved survival (AOR [95 % CI]: 3.24 [1.24-8.47]; p = 0.016). Conclusion In non-trauma patients undergoing massive transfusion, increasing FFP: PRBC ratio was associated with improved survival. A ratio >1:3 significantly improved survival probability.