title: Hemostatic resuscitation during surgery improves survival in patients with traumatic-induced coagulopathy.
abstract: BACKGROUND
  Although hemostatic resuscitation with a 1:1 ratio of fresh-frozen plasma (FFP) to packed red blood cells (PRBC) after severe hemorrhage has been shown to improve survival, its benefit in patients with traumatic-induced coagulopathy (TIC) after >10 units of PRBC during operation has not been elucidated. We hypothesized that a survival benefit would occur when early hemostatic resuscitation was used intraoperatively after injury in patients with TIC.
  
  
  METHODS
  A 7-year retrospective study of patients with emergency department diagnosis of TIC after transfusion of >10 units of PRBC in the operating room. TIC was defined as initial emergency department international normalized ratio > 1.2, prothrombin time > 16 seconds, and partial thromboplastin time > 50 seconds. Patients were divided into FFP:PRBC ratios of 1:1, 1:2, 1:3, and 1:4. Patients with diagnosis of TIC who received transfusion of both FFP and PRBC during surgery were included. Other variables evaluated included age, gender, mechanism of injury, initial base deficit, mean operative time, trauma intensive care unit length of stay (TICU LOS) and Injury Severity Score. The primary outcome measure evaluated was the impact of the early FFP:PRBC ratio on mortality.
  
  
  RESULTS
  Four hundred thirty-five patients underwent emergency operations postinjury and received FFP with >10 units of PRBC in the operating room; 135 (31.0%) of these patients had TIC and 53 died (39.5% mortality). Mean operative time was 137 minutes (SD +/- 49). There were no differences with regard to age, gender, mechanism of injury, initial base deficit, or Injury Severity Score among all groups. A significant difference in mortality was found in patients who received >10 units of PRBC when FFP:PRBC ratio was 1:1 versus 1:4 (28.2% vs. 51.1%, p = 0.03). Intermediate mortality rates were noted in patients with 1:2 and 1:3 ratios (38% and 40%, respectively). From a linear regression model, 13 days of increased TICU LOS was observed among 1:4 group compared with 1:1 group (p < 0.01).
  
  
  CONCLUSIONS
  TIC is common after severe injury and is associated with a high mortality in patients transfused with >10 units of PRBC during surgery. Early hemostatic resuscitation during first hours after injury improves survival with shorter TICU LOS in patients with TIC.
authors: Department of Surgery and Anesthesia, Tulane University School of Medicine, LA-Trauma/Critical Care, New Orleans, Louisiana 70112-2699, USA. jduchesn@tulane.edu
authors: Juan C
authors: JC
authors: Duchesne
authors: Tareq M
authors: TM
authors: Islam
authors: Lance
authors: L
authors: Stuke
authors: Jeremy R
authors: JR
authors: Timmer
authors: James M
authors: JM
authors: Barbeau
authors: Alan B
authors: AB
authors: Marr
authors: John P
authors: JP
authors: Hunt
authors: Jeffrey D
authors: JD
authors: Dellavolpe
authors: Georgia
authors: G
authors: Wahl
authors: Patrick
authors: P
authors: Greiffenstein
authors: Glen E
authors: GE
authors: Steeb
authors: Clifton
authors: C
authors: McGinness
authors: Christopher C
authors: CC
authors: Baker
authors: Norman E
authors: NE
authors: McSwain
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000379:methods*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006487:Hemostasis / Q000502:physiology*; D006489:Hemostatic Techniques; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery