title: Liquid plasma use during "super" massive transfusion protocol.
abstract: BACKGROUND
  A massive transfusion protocol (MTP) presents a logistical challenge for most blood banks and trauma centers. We compare the ratio of packed red blood cells (PRBC) and plasma transfused over serial time points in those requiring MTP (10-30 U PRBC/24 h) to those requiring "super" MTP (S-MTP; >30 U PRBC/24 h) and test the hypothesis that changes in allocation of blood products with use of readily transfusable liquid plasma (LP) improves the ratio of PRBC and plasma during S-MTP.
  
  
  METHODS
  All transfused trauma patients (n = 1305) from January 01, 2009-April, 03, 2015 were reviewed. PRBC:plasma ratio was compared for MTP (n = 277) and S-MTP (n = 61) patients, before and after the availability of LP at our institution. Data are reported as mean ± standard deviation or median (interquartile range).
  
  
  RESULTS
  Age was 41 ± 19 y, 52% blunt mechanism, injury severity score 32 ± 16, and 46.3% mortality. In 24 h, requirements were 17 (14) U PRBC and 10 (11) U plasma, with a PRBC:plasma of 1.6 (0.8). Within the first hour, PRBC:plasma for S-MTP versus MTP was 2.1:1 versus 1.7:1 (P = 0.017). With LP, S-MTP patients received significantly lower PRBC:plasma at the first hour (P < 0.001). Before institutional changes, PRBC:plasma positively correlated with PRBC transfused at hour 1 (r = 0.410, R(2) = 0.168, P < 0.001); after institutional changes and the advent of LP, there was no correlation (r = 0.177, R(2) = 0.031, P = 0.219).
  
  
  CONCLUSIONS
  Within the first hour of transfusion, units of PRBC transfused positively correlated with PRBC:plasma, and patients receiving S-MTP had higher PRBC:plasma than those receiving MTP. Changes in our institution's MTP protocol to include LP improved the early PRBC:plasma transfused in patients requiring S-MTP.
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Sherry
authors.initials: S
authors.lastname: Shariatmadar
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mena M
authors.initials: MM
authors.lastname: Hanna
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Mora
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Juliet J
authors.initials: JJ
authors.lastname: Ray
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Roman
authors.initials: R
authors.lastname: Dudaryk
authors.affiliation: Departments of Surgery, Pathology, and Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: kproctor@miami.edu.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acute coagulopathy of trauma; FFP; Hemostatic resuscitation; MTP