title: Aggressive fresh frozen plasma (FFP) with massive blood transfusion in the absence of acute traumatic coagulopathy.
abstract: BACKGROUND
  A high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) is currently recognised as the standard of care in some centres during massive transfusion post trauma. The aim of this study was to test whether the presumption of benefit held true for severely injured patients who received a massive transfusion, but did not present with acute traumatic coagulopathy.
  
  
  METHODS
  Data collected in The Alfred Trauma Registry over a 6 year period were reviewed. Included patients were sub-grouped by a high FFP:PRBC ratio (≥1:2) in the first 4 h and compared to patients receiving a lower ratio. Outcomes studied were associations with mortality, hours in the intensive care unit and hours of mechanical ventilation.
  
  
  RESULTS
  Of 4164 eligible patients, 374 received a massive transfusion and 179 (49.7%) patients who did not have coagulopathy were included for analysis. There were 66 patients who received a high ratio of FFP:PRBC, and were similar in demographics and presentation to 113 patients who received a lower ratio. There was no significant difference in mortality between the two groups (p=0.80), and the FFP:PRBC ratio was not significantly associated with mortality, ICU length of stay or mechanically ventilated hours.
  
  
  CONCLUSIONS
  A small proportion of major trauma patients received a massive blood transfusion in the absence of acute traumatic coagulopathy. Aggressive FFP transfusion in this group of patients was not associated with significantly improved outcomes. FFP transfusion carries inherent risks with substantial costs and the population most likely to benefit from a high FFP:PRBC ratio needs to be clearly defined.
authors.affiliation: Transfusion Research Unit, Department of Epidemiology & Preventive Medicine, Monash University, Australia. b.mitra@alfred.org.au
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
mesh_terms: D000208:Acute Disease; D000328:Adult; D001778:Blood Coagulation Disorders / Q000175:diagnosis; D016913:Blood Component Transfusion / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010949:Plasma; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications