title: A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study.
abstract: BACKGROUND
  In trauma, most hemorrhagic deaths occur within the first 6 hours. This study examined the effect on survival of high ratios of fresh frozen plasma (FFP) and platelets (PLTs) to packed red blood cells (PRBCs) in the first 6 hours.
  
  
  METHODS
  Records of 466 massive transfusion trauma patients (>or=10 U of PRBCs in 24 hours) at 16 level 1 trauma centers were reviewed. Transfusion ratios in the first 6 hours were correlated with outcome.
  
  
  RESULTS
  All groups had similar baseline characteristics. Higher 6-hour ratios of FFP:PRBCs and PLTs:PRBCs lead to improved 6-hour mortality (from 37.3 [in the lowest ratio group] to 15.7 [in the middle ratio group] to 2.0% [in the highest ratio group] and 22.8% to 19.0% to 3.2%, respectively) and in-hospital mortality (from 54.9 to 41.1 to 25.5% and 43.7% to 46.8% to 27.4%, respectively). Initial higher ratios of FFP:PRBCs and PLTs:PRBCs decreased overall PRBC transfusion.
  
  
  CONCLUSIONS
  The early administration of high ratios of FFP and platelets improves survival and decreases overall PRBC need in massively transfused patients. The largest difference in mortality occurs during the first 6 hours after admission, suggesting that the early administration of FFP and platelets is critical.
authors.affiliation: Department of Surgery, Trauma/Critical Care Section, Oregon Health & Science University, Portland, OR 97239, USA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Zink
authors.forename: Chitra N
authors.initials: CN
authors.lastname: Sambasivan
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D001792:Blood Platelets; D001803:Blood Transfusion; D017707:Erythrocyte Transfusion / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D010949:Plasma; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000401:mortality*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality*