TY - JOUR
T1 - Liquid plasma use during “super” massive transfusion protocol
AU - Allen, Casey J.
AU - Shariatmadar, Sherry
AU - Meizoso, Jonathan P.
AU - Hanna, Mena M.
AU - Mora, Jose L.
AU - Ray, Juliet J.
AU - Namias, Nicholas
AU - Dudaryk, Roman
AU - Proctor, Kenneth G.
N1 - Funding Information:
The authors recognize the nursing and administrative staff at Ryder Trauma Center for their cooperation and assistance with the patients and their families. Supported in part by: grants #N140610670 from the Office of Naval Research and W81XWH-11-2-0098 from U.S. Army Medical Research and Materiel Command. Authors' contributions: C.J.A. is directly responsible for all aspects of this study and participated in the collection, analysis, and interpretation of the data; drafting and revision of the article, figures, and tables. S.S. J.P.M. M.M.H. J.L.M. J.J.R. N.N. and R.D. participated in the revision of the article, figures, and tables. N.N. and R.D. were medically responsible for the patients and participated in the review of the article, figures, and tables. K.G.P. had overall responsibility for the study; including conception and experimental design; analysis and interpretation of data; drafting and revision of the article, figures, and tables; statistical expertise and evaluation; obtaining funding for this project; and supervision. None of the authors have declared conflicts of interest.
PY - 2015/12
Y1 - 2015/12
N2 - Background: A massive transfusion protocol (MTP) presents a logistical challenge for most blood banks and trauma centers. We compare the ratio of packed red blood cells (PRBC) and plasma transfused over serial time points in those requiring MTP (10–30 U PRBC/24 h) to those requiring “super” MTP (S-MTP; >30 U PRBC/24 h) and test the hypothesis that changes in allocation of blood products with use of readily transfusable liquid plasma (LP) improves the ratio of PRBC and plasma during S-MTP. Materials and methods: All transfused trauma patients (n = 1305) from January 01, 2009–April, 03, 2015 were reviewed. PRBC:plasma ratio was compared for MTP (n = 277) and S-MTP (n = 61) patients, before and after the availability of LP at our institution. Data are reported as mean ± standard deviation or median (interquartile range). Results: Age was 41 ± 19 y, 52% blunt mechanism, injury severity score 32 ± 16, and 46.3% mortality. In 24 h, requirements were 17 (14) U PRBC and 10 (11) U plasma, with a PRBC:plasma of 1.6 (0.8). Within the first hour, PRBC:plasma for S-MTP versus MTP was 2.1:1 versus 1.7:1 (P = 0.017). With LP, S-MTP patients received significantly lower PRBC:plasma at the first hour (P < 0.001). Before institutional changes, PRBC:plasma positively correlated with PRBC transfused at hour 1 (r = 0.410, R2 = 0.168, P < 0.001); after institutional changes and the advent of LP, there was no correlation (r = 0.177, R2 = 0.031, P = 0.219). Conclusions: Within the first hour of transfusion, units of PRBC transfused positively correlated with PRBC:plasma, and patients receiving S-MTP had higher PRBC:plasma than those receiving MTP. Changes in our institution's MTP protocol to include LP improved the early PRBC:plasma transfused in patients requiring S-MTP.
AB - Background: A massive transfusion protocol (MTP) presents a logistical challenge for most blood banks and trauma centers. We compare the ratio of packed red blood cells (PRBC) and plasma transfused over serial time points in those requiring MTP (10–30 U PRBC/24 h) to those requiring “super” MTP (S-MTP; >30 U PRBC/24 h) and test the hypothesis that changes in allocation of blood products with use of readily transfusable liquid plasma (LP) improves the ratio of PRBC and plasma during S-MTP. Materials and methods: All transfused trauma patients (n = 1305) from January 01, 2009–April, 03, 2015 were reviewed. PRBC:plasma ratio was compared for MTP (n = 277) and S-MTP (n = 61) patients, before and after the availability of LP at our institution. Data are reported as mean ± standard deviation or median (interquartile range). Results: Age was 41 ± 19 y, 52% blunt mechanism, injury severity score 32 ± 16, and 46.3% mortality. In 24 h, requirements were 17 (14) U PRBC and 10 (11) U plasma, with a PRBC:plasma of 1.6 (0.8). Within the first hour, PRBC:plasma for S-MTP versus MTP was 2.1:1 versus 1.7:1 (P = 0.017). With LP, S-MTP patients received significantly lower PRBC:plasma at the first hour (P < 0.001). Before institutional changes, PRBC:plasma positively correlated with PRBC transfused at hour 1 (r = 0.410, R2 = 0.168, P < 0.001); after institutional changes and the advent of LP, there was no correlation (r = 0.177, R2 = 0.031, P = 0.219). Conclusions: Within the first hour of transfusion, units of PRBC transfused positively correlated with PRBC:plasma, and patients receiving S-MTP had higher PRBC:plasma than those receiving MTP. Changes in our institution's MTP protocol to include LP improved the early PRBC:plasma transfused in patients requiring S-MTP.
KW - Acute coagulopathy of trauma
KW - FFP
KW - Hemostatic resuscitation
KW - MTP
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U2 - 10.1016/j.jss.2015.06.022
DO - 10.1016/j.jss.2015.06.022
M3 - Article
C2 - 26182996
AN - SCOPUS:85027936475
VL - 199
SP - 622
EP - 628
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
IS - 2
ER -