title: Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation.
abstract: BACKGROUND
  Recent retrospective studies have found high fresh frozen plasma (FFP) to packed red blood cell (PRBC) ratios during trauma resuscitation to be associated with improved mortality. Whilst this association may be related to a mortality bias present in these studies, there has been an overall tendency towards a 1:1 FFP:PRBC ratio in massive transfusion guidelines worldwide. The aim of this study was to retrospectively review the administration of FFP in patients undergoing massive transfusion during trauma resuscitation, to add to the evidence base for massive transfusion guidelines.
  
  
  METHODS
  Multi-trauma patients who were administered blood transfusions of 5units or more of packed red blood cells (PRBCs) in the first 4h were included in this study. Mortality was the primary endpoint with length of hospital stay, ICU hours and mechanically ventilated hours secondary endpoints.
  
  
  RESULTS
  There were 331 patients included in this study with a median Injury Severity Score (ISS) of 36 (25-50) and a mortality of 29.9%. There was little change in the ratio of FFP:PRBC transfused per patient from 2005 to 2008. A low FFP:PRBC ratio in the first 4h of resuscitation, older age, low initial GCS and coagulopathy on presentation were significant independent factors associated with mortality. When deaths in the first 24h were excluded, the FFP:PRBC ratio had no association with mortality.
  
  
  CONCLUSIONS
  This study has shown increased initial survival in association with higher FFP:PRBC ratios during massive transfusion in a population with a high proportion of blunt injuries. The association is difficult to interpret because of an inherent survival bias. The optimal ratio of FFP:PRBC during massive transfusion may be different to 1:1 and further prospective research is required. There is now an increasing need for well designed randomised controlled trials to determine the best FFP:PRBC ratio for the resuscitation of blunt multi-trauma patients.
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia. b.mitra@alfred.org.au
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mori
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Alison
authors.initials: A
authors.lastname: Street
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003422:Critical Care / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D010949:Plasma; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012151:Resuscitation / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000628:therapy; D055815:Young Adult