title: Fresh frozen plasma/red blood cell resuscitation regimen that restores procoagulants without causing adult respiratory distress syndrome.
abstract: BACKGROUND
  Controversy exists about the ideal fresh frozen plasma/red blood cell (FFP/RBC) ratio for resuscitation of patients requiring massive transfusion (MT). This study correlates the FFP/RBC with clotting time (CT), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT); with procoagulants (fibrinogen [FI], factor 5 [FV], and factor 8 [FVIII]); and with adult respiratory distress syndrome (pO2/FIO2).
  
  
  METHODS
  The 32 patients studied in operating room (OR) were in shock for 47 minutes and received an average of 17.6 units RBC, 4.2 units FFP, and 14.2 L balanced electrolyte solution. The 53 patients (including 22 of the OR patients), studied an average of 9.5 hours after operation, had an average shock time of 42 minutes, and received 17.4 units RBC, 4.6 units FFP, and 12.3 L balanced electrolyte solution in OR.
  
  
  RESULTS
  The FFP/RBC in OR averaged 0.3:1 (range: 0.1:1 to 0.9:1). The OR study, done after a minimum of 10 RBC units at 3.8 hours, showed a PT of 3.5 seconds off normal (international normalized ratio < 1.3), a PTT of 34 seconds, and TT of 7.9 seconds off normal. FI, FV, and FVIII were restored to 148 mg/dL, 54%, and 81%. The pO2/FIO2 was 282. The early post-OR study showed a PT of 2.3 seconds off normal (international normalized ratio = 1.2), a PTT of 32 seconds, a TT of 7.2 seconds off normal, an FI of 207 mg/dL, an FV of 64%, an FVIII of 102%, and a pO2/FIO2 of 332. Both OR and early post-OR CTs and procoagulant levels are associated with adequate coagulation. All patients with a 0.31:1 or higher FFP/RBC had sufficient restoration of CTs and procoagulants.
  
  
  CONCLUSIONS
  These data show that an FFP/RBC ratio above 0.31:1 in injured patients requiring MT restores CTs and procoagulant to clinically effective levels while not causing adult respiratory distress syndrome. Future studies on defining the ideal FFP/RBC ratio for MT should monitor CTs, procoagulants, and organ function.
authors.affiliation: Department of Surgery, Wayne State University, Detroit, Michigan, USA. clucas@med.wayne.edu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Lucas
authors.forename: Anna M
authors.initials: AM
authors.lastname: Ledgerwood
mesh_terms: D000328:Adult; D001777:Blood Coagulation; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods; D005165:Factor V / Q000032:analysis; D005169:Factor VIII / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D010314:Partial Thromboplastin Time; D010949:Plasma; D011446:Prospective Studies; D011517:Prothrombin Time; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000097:blood / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D013918:Thrombin Time; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood / Q000628:therapy
chemical_list: D005165:Factor V; D005169:Factor VIII; D005340:Fibrinogen