Increased Plasma and Platelet to Red Blood Cell Ratios Improves Outcome in 466 Massively Transfused Civilian Trauma Patients

Holcomb, John B.; Wade, Charles E.; Michalek, Joel E.; Chisholm, Gary B.; Zarzabal, Lee Ann; Schreiber, Martin A.; Gonzalez, Ernest A.; Pomper, Gregory J.; Perkins, Jeremy G.; Spinella, Phillip C.; Williams, Kari; Park, Myung S.

doi:10.1097/sla.0b013e318185a9ad

Cited by 996 publications

(647 citation statements)

References 94 publications

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“…A subsequent study from 16 US trauma centres between 2005 and 2006 reported similar findings, with retrospective analysis showing improved survival with ratios of FFP:PRBC greater than 1:2 [19]. These results, and the biologically plausible concept of treating haemorrhage with component ratios approaching those of whole blood, have led to the development of guidelines recommending early empirical use of FFP in traumatic bleeding [20].…”

Section: Haemostatic Resuscitationsupporting

confidence: 52%

Haemorrhage and coagulopathy in the Defence Medical Services

et al. 2012

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SummaryOver the past 12 years, the United Kingdom Defence Medical Services have evolved an integrated ‘damage control resuscitation – damage control surgery’ sequence for the management of patients sustaining complex injuries. During 2009, over 3200 units of blood products were administered as massive transfusions to severely injured UK personnel. An important part of the approach to traumatic bleeding is the early, empirical use of predefined ratios of blood and clotting products. As soon as control of bleeding is achieved, current practice is to switch towards a tailored transfusion, based on clinical and laboratory assessments, including point‐of‐care coagulation testing. A key goal is to provide resuscitation seamlessly throughout surgery, so that patients leave the operating room with their normal physiology restored. This article outlines the current management of haemorrhage and coagulation employed in Afghanistan from the point of wounding to transfer back to the National Health Service.

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Section: Haemostatic Resuscitationsupporting

confidence: 52%

Haemorrhage and coagulopathy in the Defence Medical Services

et al. 2012

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“…The Trauma Outcomes Group collected data from 466 massive transfusion patients from 16 level 1 centers from 2005 to 2006. 35 These data documented the wide variability in transfusion practice and outcomes across the United States. This study demonstrated that outcomes were improved with a more balanced ratio of at least 1:1:2.…”

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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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“…In severe ongoing hemorrhage survival is improved when RBC and plasma are used in 1:1 basis 28 . Timely transfusion of platelets at 1:1:1 rates is even more important to prevent coagulopathy 29 .…”

Section: Resultsmentioning

confidence: 99%

The Burden of Major Obstetric Hemorrhage in Near Miss in a Tertiary Care Centre in Kerala

Umadevi¹

2017

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Increased Plasma and Platelet to Red Blood Cell Ratios Improves Outcome in 466 Massively Transfused Civilian Trauma Patients

Cited by 996 publications

References 94 publications

Haemorrhage and coagulopathy in the Defence Medical Services

Haemorrhage and coagulopathy in the Defence Medical Services

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

The Burden of Major Obstetric Hemorrhage in Near Miss in a Tertiary Care Centre in Kerala

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