title: Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME).
abstract: BACKGROUND
  Resuscitation of rapidly bleeding trauma patients with units of red blood cells (RBCs) and plasma given in a 1:1 ratio has been associated with improved outcome. However, demonstration of a benefit is confounded by survivor bias, and past work from our group has been unable to demonstrate a benefit.
  
  
  METHODS
  We identified 438 adult direct primary trauma admissions at risk for massive transfusion who received 5 or more RBC units in the first 24 hours and had a probability of survival of 0.010 to 0.975. We correlated survival with RBC and plasma use by hour, both as a ratio (units of plasma/units of RBC) and as a plasma deficit (units of RBC - units of plasma) in the group as a whole and among those using 5 to 9 and more than 9 units of RBCs.
  
  
  RESULTS
  Resuscitation was essentially complete in 58.3% by the end of the third hour and 77.9% by the end of the sixth hour. Mortality by hour was significantly associated with worse plasma deficit status in the first 2 hours of resuscitation (p < 0.001 and p < 0.01) but not with plasma ratio. In a subgroup with a Trauma Revised Injury Severity Score of 0.200 to 0.800, early plasma repletion was associated with less blood product use independently of injury severity (p < 0.001).
  
  
  CONCLUSIONS
  1) The efficacy of plasma repletion plays out in the first few hours of resuscitation, 2) plasma deficit may be a more sensitive marker of efficacy in some populations, and 3) early plasma repletion appears to prevent some patients from going on to require massive transfusion.
authors.affiliation: Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
authors.forename: Andreas R
authors.initials: AR
authors.lastname: de Biasi
authors.forename: Lynn G
authors.initials: LG
authors.lastname: Stansbury
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000378:metabolism*; D012151:Resuscitation / Q000379:methods* / Q000401:mortality*; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult