The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients.
OBJECTIVE
High ratios of Plasma to Packed Red Blood Cells (FFP:PRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy.


METHODS
Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFP:PRBC ratio cut-offs (1:2 and 1:3) and adjusted mortality derived.


RESULTS
Over 8 years, 29 % (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFP:PRBC ratios (45 % for ratio ≤1:8, 33 % for ratio >1:8 and ≤1:3, 27 % for ratio >1:3 and ≤1:2 and 25 % for ratio >1:2). Increasing FFP:PRBC ratio independently predicted survival (AOR [95 % CI]: 1.91 [1.35-2.71]; p < 0.001). Patients achieving a ratio >1:3 had improved survival (AOR [95 % CI]: 3.24 [1.24-8.47]; p = 0.016).


CONCLUSIONS
In non-trauma patients undergoing massive transfusion, increasing FFP:PRBC ratio was associated with improved survival. A ratio >1:3 significantly improved survival probability.
University Medical Center Brackenridge, University of Texas at Austin Dell Medical School, Austin, TX, USA. pgteixeira@seton.org.
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Teixeira
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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Inaba
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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Karamanos
University of Arizona, Tucson, AZ, USA.
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Rhee
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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Shulman
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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Skiada
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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Chouliaras
Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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Demetriades
D016913:Blood Component Transfusion / Q000401:mortality*; D004638:Emergency Treatment; D004912:Erythrocytes; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010949:Plasma; D011183:Postoperative Complications / Q000628:therapy; D012151:Resuscitation / Q000401:mortality*; D016019:Survival Analysis; D014481:United States
Blood components ratio; Emergency surgery; Massive transfusion; Plasma