Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME)

Abstract

Background: Resuscitation of rapidly bleeding trauma patients with units of red blood cells (RBCs) and plasma given in a 1:1 ratio has been associated with improved outcome. However, demonstration of a benefit is confounded by survivor bias, and past work from our group has been unable to demonstrate a benefit.

Study design and methods: We identified 438 adult direct primary trauma admissions at risk for massive transfusion who received 5 or more RBC units in the first 24 hours and had a probability of survival of 0.010 to 0.975. We correlated survival with RBC and plasma use by hour, both as a ratio (units of plasma/units of RBC) and as a plasma deficit (units of RBC - units of plasma) in the group as a whole and among those using 5 to 9 and more than 9 units of RBCs.

Results: Resuscitation was essentially complete in 58.3% by the end of the third hour and 77.9% by the end of the sixth hour. Mortality by hour was significantly associated with worse plasma deficit status in the first 2 hours of resuscitation (p < 0.001 and p < 0.01) but not with plasma ratio. In a subgroup with a Trauma Revised Injury Severity Score of 0.200 to 0.800, early plasma repletion was associated with less blood product use independently of injury severity (p < 0.001).

Conclusions: 1) The efficacy of plasma repletion plays out in the first few hours of resuscitation, 2) plasma deficit may be a more sensitive marker of efficacy in some populations, and 3) early plasma repletion appears to prevent some patients from going on to require massive transfusion.

Conflict of interest statement

Conflict of Interest: The authors report no financial conflict of interest with the content of this manuscript.

© 2011 American Association of Blood Banks.

Figures

Figure 1

Mean hourly usage of units of RBC and plasma among patients with probability of survival scores (TRISS) between 0.010 to 0.975 and categorized as A) all patients receiving at least 5 units of RBC in the first 24 hours, B) patients receiving 5 to 9 units of RBC in the first 24 hours and C) patients receiving >9 units of RBC in the first 24 hours.

Figure 2

Figure 2a. Proportional mortality among patients who had probability of survival scores (TRISS) between 0.010 to 0.975, and who survived to specific time points, grouped by deficit status at that time point as ‘Low’ deficit = 0–2 units of plasma; ‘Moderate deficit’ = 3–6 units of plasma; ‘High deficit’ = >6 units of plasma and categorized as A) all patients receiving at least 5 units of RBC in the first 24 hours, B) patients receiving 5 to 9 units of RBC in the first 24 hours and C) patients receiving >9 units of RBC in the first 24 hours.