title: Application of damage control resuscitation strategies to patients with severe traumatic hemorrhage: review of plasma to packed red blood cell ratios at a single institution.
abstract: When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (≥0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Younghwan
authors.identifier: 0000-0003-3836-8743
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea. ; Department of Biomedical Sciences, Graduate School, Ajou University School of Medicine, Suwon, Korea.
authors.forename: KiYoung
authors.identifier: 0000-0003-3720-6574
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea. ; Department of Biomedical Sciences, Graduate School, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jihyun
authors.identifier: 0000-0002-2639-1594
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jiyoung
authors.identifier: 0000-0003-4813-1096
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yunjung
authors.identifier: 0000-0001-5708-1428
authors.initials: Y
authors.lastname: Heo
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Heejung
authors.identifier: 0000-0002-0687-007X
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Kugjong
authors.identifier: 0000-0002-5468-3340
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Kyoungwon
authors.identifier: 0000-0001-7895-0362
authors.initials: K
authors.lastname: Jung
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology; D001803:Blood Transfusion; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010361:Patients; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology; D012151:Resuscitation; D012189:Retrospective Studies; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: Blood Product Ratio; Resuscitation; Survival; Transfusion; Trauma