title: Massive transfusion in trauma: blood product ratios should be measured at 6 hours.
abstract: BACKGROUND
  Most potentially preventable haemorrhagic deaths occur within 6 h of injury. Conventionally, blood component therapy delivery is measured by 24-h cumulative totals and ratios. The study aim was to examine the effect of a massive transfusion protocol (MTP) on early (6 h) balanced component therapy.
  
  
  METHODS
  An 88-month retrospective clinical study at a level 1 trauma centre was undertaken, examining consecutive trauma patients receiving ≥10 units of packed red blood cells (PRBCs) within 24 h, before (pre-MTP) and after implementation of MTP. Demographic data, injury severity score (ISS), abbreviated injury scale (AIS), shock parameters, coagulation profile, the need for surgical intervention (<24 h), mortality and intensive care unit length of stay were collected. The ratios of blood products given by 6 h, by 24 h and the time between administrations of components was collected and analysed.
  
  
  RESULTS
  Pre-MTP and MTP patients had similar demographics, shock severity and initial laboratory findings. Despite MTP patients having had a higher ISS (42 ± 12 versus 36 ± 12, P < 0.05) and AIS head score (2.6 ± 1.8 versus 1.6 ± 2.0, P < 0.05), there was no difference in mortality. Area under the curve (AUC) of the MTP period showed earlier delivery of higher median ratios of fresh frozen plasma (FFP)/PRBC (P= 0.004). Similar findings were found for cryoprecipitate/PRBC and platelet/PRBC ratios. By 24 h, the AUC for FFP/PRBC ratios were no different.
  
  
  CONCLUSIONS
  Implementation of MTP resulted in earlier balanced transfusion. The difference between the FFP/PRBC ratios of the two types of resuscitations levelled by 24 h. The efficacy of component therapy delivery should be measured earlier than 24 h.
authors.affiliation: Department of Traumatology, Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Krisztian
authors.initials: K
authors.lastname: Sisak
authors.forename: Kathleen
authors.initials: K
authors.lastname: Soeyland
authors.forename: Monique
authors.initials: M
authors.lastname: McLeod
authors.forename: Melanie
authors.initials: M
authors.lastname: Jansen
authors.forename: Natalie
authors.initials: N
authors.lastname: Enninghorst
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D002985:Clinical Protocols; D017707:Erythrocyte Transfusion / Q000379:methods*; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion / Q000379:methods; D012044:Regression Analysis; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen