Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients

Thomas M. Scalea, Kelly M. Bochicchio, Kim Lumpkins, John R. Hess, Richard Dutton, Anne Pyle, Grant V. Bochicchio

Research output: Contribution to journalArticle

Abstract

Objectives: Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy. Methods: Prospective data were collected on 806 consecutive trauma patients admitted to the intensive care unit over 2 years. Patients were stratified by PRBC:FFP transfusion ratio over the first 24 hours. Stepwise regression models were performed controlling for age, gender, mechanism of injury, injury severity, and acute physiology and chronic health evaluation (APACHE) 2 score to determine if early aggressive use of PRBC:FFP improved outcome. Results: Seventy-seven percent of patients were male (N = 617) and 85% sustained blunt injury (n = 680). Mean age, injury severity score (ISS), and APACHE score were 43 ± 20 years, 29 ± 13, and 13 ± 7, respectively. Mean number of PRBCs and FFP transfused were 7.7 ± 12 U, 6 U, and 5 ± 12 U, respectively. Three hundred sixty-five (45%) patients were transfused in the first 24 hours. Sixty-eight percent (n = 250) of them received both PRBCs and FFP. Analyzing these patients by stepwise regression controlling for all significant variables, the PRBC:FFP ratio did not predict intensive care unit days, hospital days, or mortality even in patients who received massive transfusion (≥ 10 U). Furthermore, there was no significant difference in outcome when comparing patients who had a 1:1 PRBC:FFP ratio with those who did not receive any FFP. Conclusion: Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.

Original languageEnglish (US)
Pages (from-to)578-583
Number of pages6
JournalAnnals of Surgery
Volume248
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Scalea, T. M., Bochicchio, K. M., Lumpkins, K., Hess, J. R., Dutton, R., Pyle, A., & Bochicchio, G. V. (2008). Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients. Annals of Surgery, 248(4), 578-583. https://doi.org/10.1097/SLA.0b013e31818990ed