Red-blood-cell to plasma ratios transfused during massive transfusion are associated with mortality in severe multiple injury: a retrospective analysis from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie.
BACKGROUND
To test whether an acute transfusion practice of packed red blood cells (pRBC) : fresh-frozen plasma (FFP) 1 : 1 would be associated with reduced mortality in acute bleeding multiply injury.


METHODS
Retrospective analysis using the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie 2002-2006) on primary admissions with substantial injury (Injury Severity Score > 16) and massive transfusion (> 10 pRBCs). Seven hundred thirteen patients were divided into three groups according to the pRBC : FFP ratio transfused, that is, (i) pRBC : FFP > 1.1; (ii) pRBC : FFP 0.9-1.1 (1 : 1); and (iii) pRBC : FFP < 0.9, and mortality rates were compared.


RESULTS
Four hundred ninety-seven (69.7%) of patients were male, the mean age was 40.1 (+/- 18.3) years. Injury characteristics and pathophysiological state upon emergency room arrival were comparable between groups. Out of 713, 484 patients had undergone massive transfusion with pRBC : FFP > 1.1, 114 with pRBC : FFP 0.9-1.1 (1 : 1), and 115 with pRBC : FFP < 0.9 ratios. Acute mortality (< 6 h) rates for pRBC : FFP > 1.1, pRBC : FFP 0.9-1.1 (1 : 1), and pRBC : FFP < 0.9 ratios were 24.6, 9.6 and 3.5% (P < 0.0001), 24-h mortality rates were 32.6, 16.7 and 11.3% (P < 0.0001), and 30-day mortality rates were 45.5, 35.1 and 24.3% (P < 0.001). The frequency for septic complications and organ failure was higher in the pRBC : FFP 0.9-1.1 (1 : 1) group, ventilator days and length of stays for intensive care unit and overall in-hospital were highest in the pRBC : FFP < 0.9 ratio group (P < 0.0005).


CONCLUSIONS
An association between pRBC : FFP transfusion ratios and mortality to favour early aggressive FFP administration was observed. Further investigation is necessary prior to recommending routine 1 : 1 or more aggressive FFP use in exsanguinating patients.
Department of Trauma and Orthopedic Surgery, and Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany. marc.maegele@t-online.de
M
M
Maegele
R
R
Lefering
T
T
Paffrath
T
T
Tjardes
C
C
Simanski
B
B
Bouillon
D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000517:prevention & control; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality*; D010949:Plasma; D012042:Registries / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality; D015599:Trauma Severity Indices