title: Impact of infusion rates of fresh frozen plasma and platelets during the first 180 minutes of resuscitation.
abstract: BACKGROUND
  Whether high-ratio resuscitation (HRR) provides patients with survival advantage remains controversial. We hypothesized a direct correlation between HRR infusion rates in the first 180 minutes of resuscitation and survival.
  
  
  METHODS
  This was a retrospective analysis of massively transfused trauma patients surviving more than 30 minutes and undergoing surgery at a level 1 trauma center. Mean infusion rates (MIR) of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (Plt) were calculated for length of intervention (emergency department [ED] time + operating room [OR] time). Patients were categorized as HRR (FFP:PRBC > 0.7, and/or Plts: PRBC > 0.7) vs low-ratio resuscitation (LRR). Student's t-tests and chi-square tests were used to compare survivors with nonsurvivors. Cox proportional hazards regression models and Kaplan-Meier curves were generated to evaluate the association between MIR for FFP:PRBC and Plt:PRBC and 180-minute survival.
  
  
  RESULTS
  There were 151 patients who met criteria: 121 (80.1%) patients survived 180 minutes (MIR:PRBC 71.9 mL/min, FFP 92.0 mL/min, Plt 3.5 mL/min) vs 30 (19.9%) who did not survive (MIR:PRBC 47.3 mL/min, FFP 33.7 mL/min, Plt 1.1 mL/min), p = 0.43, p < 0.0001 and p < 0.011, respectively. A Cox regression model evaluated PRBC rate, FFP rate, and Plt rate (mL/min) as mortality predictors within 180 minutes to assess if they significantly affected survival (hazard ratios 1.01 [p = 0.054], 0.97 [p < 0.0001], and 0.75 [p = 0.01], respectively). Another model used stepwise Cox regression including PRBC rate, FFP rate, and Plt rate (hazard ratios 1.00 [p = 0.85], 0.97 [p < 0.0001], and 0.88 [p = 0.24], respectively), as well as possible confounding variables.
  
  
  CONCLUSIONS
  This is the first study to examine effects of MIRs on survival. Further studies on the effects of narrow time-interval analysis for blood product resuscitation are warranted.
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors: Eric R
authors: ER
authors: Simms
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors: Dietric L
authors: DL
authors: Hennings
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors: Adam
authors: A
authors: Hauch
authors: Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
authors: Julie
authors: J
authors: Wascom
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors: Tatyana E
authors: TE
authors: Fontenot
authors: Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
authors: John P
authors: JP
authors: Hunt
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors: Norman E
authors: NE
authors: McSwain
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors: Peter C
authors: PC
authors: Meade
authors: Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
authors: Leann
authors: L
authors: Myers
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; North Oaks Shock/Trauma, Division of Trauma/Critical Care, Hammond, LA. Electronic address: duchesnej@northoaks.org.
authors: Juan C
authors: JC
authors: Duchesne
mesh_terms: D000328:Adult; D001792:Blood Platelets; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion / Q000379:methods* / Q000401:mortality; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*