Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients?
BACKGROUND
Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding.


METHODS
To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective traumatic shock database of 383 civilians.


RESULTS
Ninety-three (24%) of the traumatic shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated.


CONCLUSIONS
Civilians who arrived in traumatic shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.
Moore
Frederick A
FA
Department of Surgery, The Methodist Hospital, Houston, TX, USA. famoore@tmh.tmc.edu
Nelson
Teresa
T
McKinley
Bruce A
BA
Moore
Ernest E
EE
Nathens
Avery B
AB
Rhee
Peter
P
Puyana
Juan Carlos
JC
Beilman
Gregory J
GJ
Cohn
Stephen M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion / Q000379:methods*; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011446:Prospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult