title: Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.
abstract: BACKGROUND
  Transfusion practices across the country are changing with aggressive use of plasma (fresh-frozen plasma [FFP]) and platelets during massive transfusion with current military recommendations to use component therapy at a 1:1:1 ratio of packed red blood cells to FFP to platelets.
  
  
  METHODS
  A massive transfusion protocol (MTP) was designed to achieve a packed red blood cell:FFP:platelet ratio of 1:1:1 We prospectively gathered demographic, transfusion, and patient outcome data during the first year of the MTP and compared this with a similar cohort of injured patients (pre-MTP) receiving > or = 10 red blood cell (RBC) in the first 24 hours of hospitalization before instituting the MTP.
  
  
  RESULTS
  One hundred sixteen MTP activations occurred. Twelve non-trauma patients and 31 who did not receive 10 RBC (15 deaths, 16 early bleeding controls) were excluded. Seventy-three MTP patients were compared with 84 patients with pre-MTP who had similar demographics and injury severity score (29 vs. 29, p = 0.99). MTP patients received an average of 23.7 RBC and 15.6 FFP transfusions compared with 22.8 RBC (p = 0.67) and 7.6 FFP (p < 0.001) transfusions in pre-MTP patients. Early crystalloid usage dropped from 9.4 L (pre-MTP) to 6.9 L (MTP) (p = 0.006). Overall patient mortality was markedly improved at 24 hours, from 36% in the pre-MTP group to 17% in the MTP group (p = 0.008) and at 30 days (34% mortality MTP group vs. 55% mortality in pre-MTP group, p = 0.04). Blunt trauma survival improvements were more marked and more sustained than victims of penetrating trauma. Early deaths from coagulopathic bleeding occurred in 4 of 13 patients in the MTP group vs. 21 of 31 patients in the pre-MTP group (p = 0.023).
  
  
  CONCLUSIONS
  In the civilian setting, aggressive use of FFP and platelets drastically reduces 24-hour mortality and early coagulopathy in patients with trauma. Reduction in 30 day mortality was only seen after blunt trauma in this small subset.
authors.affiliation: Department of Surgery, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, Georgia, USA. cdente@emory.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dente
authors.forename: Beth H
authors.initials: BH
authors.lastname: Shaz
authors.forename: Jeffery M
authors.initials: JM
authors.lastname: Nicholas
authors.forename: Robert S
authors.initials: RS
authors.lastname: Harris
authors.forename: Amy D
authors.initials: AD
authors.lastname: Wyrzykowski
authors.forename: Snehal
authors.initials: S
authors.lastname: Patel
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.forename: Gary A
authors.initials: GA
authors.lastname: Vercruysse
authors.forename: David V
authors.initials: DV
authors.lastname: Feliciano
authors.forename: Grace S
authors.initials: GS
authors.lastname: Rozycki
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Salomone
authors.forename: Walter L
authors.initials: WL
authors.lastname: Ingram
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality*; D016913:Blood Component Transfusion / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D010949:Plasma; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality*