Early high ratio platelet transfusion in trauma resuscitation and its outcomes.
BACKGROUND
The optimal ratio of platelets (PLTs) to packed red blood cell (PRBC) in trauma patients requiring massive transfusion protocol (MTP) is still controversial. This report aims to describe the effect of attaining a high PLT:PRBC ratio (≥1:1.5) within 4 h postinjury on the outcomes of trauma patients receiving MTP.


METHODS
Over a 24-month period, records of all adult patients with traumatic injury who received MTP were retrospectively reviewed. Data were analyzed with respect to PLT:PRBC ratio ([high-MTP ≥1:1.5] [HMTP] vs. [low-MTP <1:1.5] [LMTP]) given within the first 4 h postinjury and also between (>4 and 24 h). Baseline demographic, clinical characteristics, complications, and outcomes were compared according to HMTP and LMTP.


RESULTS
Of the total 3244 trauma patients, PLT:PRBC ratio was attainable in 58 (1.2%) patients who fulfilled the inclusion criteria. The mean age was 32.3 ± 10.7 years; the majority were males (89.6%) with high mean Injury Severity Score (ISS): 31.9 ± 11.5 and Revise Trauma Score (RTS): 5.1 ± 2.2. There was no significant association between age, gender, type of injury, presenting hemoglobin, International Normalized Ratio, ISS, and RTS. The rate of ventilator-associated pneumonia (38.9% vs. 10.8%;P= 0.02) and wound infection (50% vs. 10.8%;P= 0.002) were significantly higher in the HMTP group. However, HMTP was associated with lower rate of multiple organ failure (MOF) (42.1% vs. 87.2%,P= 0.001) and mortality (36.8% vs. 84.6%,P= 0.001) within the first 30 days postinjury.


CONCLUSIONS
Our study revealed that early attainment of high PLT/PRBC ratio within 4 h postinjury is significantly associated with lower MOF and mortality in trauma patients.
Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar; University National Pedro Henriquez Urena, Department of Surgery, Santo Domingo, Dominican Republic, Doha, Qatar.
Ruben
R
Peralta
Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Adarsh
A
Vijay
Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar; Internal Medicine, Weill Cornell Medical College, Doha, Qatar.
Ayman
A
El-Menyar
Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Rafael
R
Consunji
Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Ibrahim
I
Afifi
Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Ismail
I
Mahmood
Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
Mohammed
M
Asim
Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA; Department of Surgery, University of Arizona, Tucson, AZ, USA.
Rifat
R
Latifi
Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.
Hassan
H
Al-Thani
Complications; mortality; packed red blood cell; platelet; transfusion ratio; trauma