Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time.
OBJECTIVE
We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).


METHODS
A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.


RESULTS
During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).


CONCLUSIONS
Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Ruben
R
Peralta
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Adarsh
A
Vijay
Clinical Research, Trauma Surgery Section, Hamad General Hospital, HMC, PO Box 3050, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Ayman
A
El-Menyar
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Rafael
R
Consunji
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Husham
H
Abdelrahman
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Ashok
A
Parchani
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Ibrahim
I
Afifi
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
Ahmad
A
Zarour
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Hassan
H
Al-Thani
Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar ; Department of Surgery, University of Arizona, Tucson, AZ USA.
Rifat
R
Latifi
Massive transfusion protocol; Outcome; Transfusion ratio; Trauma