Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients? - 20/08/11

Doi : 10.1016/j.amjsurg.2008.07.043

Frederick A. Moore, M.D. ^a,^⁎ , Teresa Nelson, M.S. ^b, Bruce A. McKinley, Ph.D. ^a, Ernest E. Moore, M.D. ^c, Avery B. Nathens, M.D., Ph.D., M.P.H. ^d, Peter Rhee, M.D., M.P.H. ^e, Juan Carlos Puyana, M.D. ^f, Gregory J. Beilman, M.D. ^g, Stephen M. Cohn, M.D. ^h
StO₂ Study Group
^a Department of Surgery, The Methodist Hospital, Houston, TX, USA
^b Technomics Research, LLC, Minneapolis, MN, USA
^c Department of Surgery, University of Colorado, Denver, CO, USA
^d Department of Surgery, University of Toronto, Toronto, Ontario, Canada
^e Department of Surgery, University of Southern California, Los Angeles, CA, USA
^f Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
^g Department of Surgery, University of Minnesota, Minneapolis, MN, USA
^h Department of Surgery, University of Texas, Health Science Center San Antonio, San Antonio, TX, USA

Corresponding author. Tel.: +1-713-790-6489; fax: +1-713-441-6148

Abstract

Background

Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding.

Methods

To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective traumatic shock database of 383 civilians.

Results

Ninety-three (24%) of the traumatic shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated.

Conclusion

Civilians who arrived in traumatic shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.

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Keywords : Traumatic shock, Massive transfusion, Coagulopathy, Multiple organ failure, Tissue hemoglobin oxygen saturation, StO₂

Plan

Methods

Study population

Massive transfusion

MT subgroup breakdown by outcome

Comparison of MT versus no MT group

MT subgroups by outcome comparisons

Comments

This study was funded by Hutchinson Technology Inc, Hutchinson, MN.

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Vol 196 - N° 6

P. 948-960 - décembre 2008 Retour au numéro

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Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients? - 20/08/11

Abstract

Background

Methods

Results

Conclusion

Plan

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