Clinical review: Fresh frozen plasma in massive bleedings - more questions than answers

Nascimento, Bartolomeu; Callum, Jeannie; Rubenfeld, Gordon D.; Neto, J. B.; Lin, Yulia; Rizoli, Sandro

doi:10.1186/cc8205

Cited by 114 publications

(74 citation statements)

References 58 publications

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“…Durante the acute resuscitation of a trauma patient, fibrinogen is most commonly replaced by plasma transfusion. The content of a standard dose of CRYO is equivalent to the amount of fibrinogen found in an average adult dose of FFP (4 units), where each unit of FFP contains 0.5 g of fibrinogen Nascimento et al, 2010). There is little published literature in trauma patients to guide when CRYO is required and what the effective dose may be.…”

Section: Introductionmentioning

confidence: 99%

Cryoprecipitate transfusion: assessing appropriateness and dosing in trauma

Nascimento¹,

Rizoli²,

Rubenfeld³

et al. 2011

Transfusion Medicine

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Cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear.This retrospective study aims to evaluate: (1) the appropriateness of cryoprecipitate transfusion in trauma; and (2) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma.Fibrinogen levels of < 1.0 g/L within 2 and 6 hours of cryoprecipitate transfusion were used for assessing appropriateness. Out of 394 events, 238 (60%) and 259 (66%) were considered appropriate using 2 and 6 hour criteria, respectively. A dose of 8.7 (±1.7) units caused a mean increase in fibrinogen levels of 0.55 (±0.24) g/L, or 0.06g/L per unit.In our hospital, where transfusion guidelines and policies for rapid blood product and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels.iii

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Section: Introductionmentioning

confidence: 99%

Cryoprecipitate transfusion: assessing appropriateness and dosing in trauma

Nascimento¹,

Rizoli²,

Rubenfeld³

et al. 2011

Transfusion Medicine

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“…Not all investigators agreed and several suggested that increased amounts of plasma and platelets would cause an increase in the incidences of ARDS, TRALI, transfusion-associated circulatory overload, and other bloodrelated complications. 33,34 In an effort to programmatically determine optimal resuscitation practice balancing risk versus benefit, we embarked on a decade-long research effort. The Trauma Outcomes Group collected data from 466 massive transfusion patients from 16 level 1 centers from 2005 to 2006.…”

mentioning

confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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“…Fresh frozen plasma is obtained via apheresis of whole blood and frozen within 8 h [59]. It contains all the clotting factors, fibrinogen, proteins C and S, and albumin.…”

Section: Blood Productsmentioning

confidence: 99%

Volume Management and Resuscitation in Trauma

Bradley

Nelson

2014

Curr Anesthesiol Rep

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Trauma remains an enormous burden on the American medical system. While patients of all ages sustain severe trauma, it remains the most common cause of death in young adults. Exsanguination from uncontrolled hemorrhage is the leading cause of preventable death among the traumatically injured. The lethal triad of trauma is a culmination of coagulopathy, acidosis, and hypothermia that can rapidly deteriorate and lead to a patient's demise if not treated accordingly. The goal of trauma resuscitation is to prevent or halt this triad while minimizing iatrogenic injury. The provider has many options available in his armamentarium for resuscitation, but each carries its own risks and benefits. Over the past two decades, trauma research has given us a better understanding of and improved management strategies for this triad. This chapter will explore the various resuscitative options available and summarize the most recent literature regarding their use.

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Clinical review: Fresh frozen plasma in massive bleedings - more questions than answers

Cited by 114 publications

References 58 publications

Cryoprecipitate transfusion: assessing appropriateness and dosing in trauma

Cryoprecipitate transfusion: assessing appropriateness and dosing in trauma

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Volume Management and Resuscitation in Trauma

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