title: The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis.
abstract: OBJECTIVE
  Transfusion ratios approaching 1:1 FFP:PRBC for trauma resuscitation have become the de facto standard of care. The aim of this study was to prospectively evaluate the effect of increasing ratios of FFP:PRBC transfusion on survival for massively transfused civilian trauma patients as well as determine if time to reach the target ratio had any effect on outcomes.
  
  
  METHODS
  This is a prospective, observational study of all trauma patients requiring a massive transfusion (≥10 PRBC in ≤24 h) at a level 1 trauma center over a 2.5-year period. The ratio of FFP:PRBC was tracked hourly up to 24 h post-initiation of massive transfusion. A logistic regression model was utilized to identify the ideal ratio associated with mortality prediction. A stepwise logistic regression was performed to identify independent predictors of mortality.
  
  
  RESULTS
  The study population was predominantly male (89 %) with a mean age of 34.8 ± 16. On admission, 22 % had a systolic blood pressure ≤90 mmHg, 47 % had a heart rate ≥120, and 25 % had a GCS ≤8. The overall mortality was 33 %. The ratio of FFP:PRBC ≥ 1:1.5 was the second most important independent predictor of mortality for this population (R (2) = 0.59). Survivors had a higher FFP:PRBC ratio at all times during the first 24 h of resuscitation.
  
  
  CONCLUSIONS
  Achieving a ratio of FFP:PRBC ≥ 1:1.5 after the initial 24 h of resuscitation significantly improves survival in massively transfused trauma patients compared to patients that achieved a ratio <1:1.5.
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bui
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Kenji.Inaba@med.usc.edu.
authors.forename: K
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ebadat
authors.affiliation: Henry Ford Hospital, Wayne State University, Detroit, MI, USA.
authors.forename: E
authors.initials: E
authors.lastname: Karamanos
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: S
authors.initials: S
authors.lastname: Byerly
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: O
authors.initials: O
authors.lastname: Okoye
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: I
authors.initials: I
authors.lastname: Shulman
authors.affiliation: Division of Trauma, Critical Care, and Acute Care Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Rhee
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC + USC Medical Center, 1200N State Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: D
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods / Q000401:mortality; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Hemorrhage; Massive transfusion; Resuscitation; Transfusion ratio; Trauma