Application of Damage Control Resuscitation Strategies to Patients with Severe Traumatic Hemorrhage: Review of Plasma to Packed Red Blood Cell Ratios at a Single Institution

• Published in: Journal of Korean medical science Vol. 29; no. 7; pp. 1007 - 1011
• Main Authors: Kim, Younghwan, Lee, KiYoung, Kim, Jihyun, Kim, Jiyoung, Heo, Yunjung, Wang, Heejung, Lee, Kugjong, Jung, Kyoungwon
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.07.2014; 대한의학회
• Subjects: Acute Lung Injury - epidemiology; Acute Lung Injury - etiology; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections - epidemiology; Blood Transfusion; Erythrocyte Transfusion - adverse effects; Female; Hemorrhage - etiology; Hemorrhage - prevention & control; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Original; Patients; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - etiology; Resuscitation; Retrospective Studies; Transfusion Reaction; Wounds and Injuries - complications; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Young Adult; 의학일반; Transfusion; Blood Product Ratio; Survival; Trauma; Resuscitation
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2014.29.7.1007

When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (≥0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.