Comparison of different plasma to packed red blood cell ratios in patients with severe traumatic hemorrhage

Zhang Geng-wei; Shan Ai-jun; Wang Jin; Zhong Xian-liang; Long Lian-gong; Zhong Yuan- bo; Liu Xun- fa

doi:10.3969/j.issn.1002-1949.2017.10.008

Abstract：Objective To compare the efficacy and safety of different plasma to packed red blood cell ratios in resuscitating patients with severe traumatic hemorrhage. Methods We retrospectively reviewed the medical records of 150 traumatic patients treated with massive transfusions from October 2011 to October 2015. Patients were divided into 3 groups according to the fresh frozen plasma(FFP): packed red blood cell(PRBC)ratio: a low -ratio(FFP/PRBC≤1:2, 51 cases), a mediate group(1:2 <FFP/PRBC≤1:1, 49 cases)and a high -ratio group(FFP/PRBC >1:1, 50 cases) . The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. Results During the first 24 hours, FFP quantities and FFP/PRBC ratios between any two groups were significantly different. To maintain the blood volume, the low-ratio group who were given less FFP, however, required more crystalloids which resulted in a poorer 24 h laboratory values. Infections and transfusion related acute lung injuries were more common in the high-ratio group, and the difference was statistically significant. Kaplan-Meier plots revealed that the 24 h survival rate was significantly higher in the mediate-ratio group(81. 6%) and the high-ratio group(82. 0%)than the low-ratio group(60. 8%)(P<0. 001). However, the 30 d survival rate in the high-ratio group sharply decreased to 62. 0%, which was not significantly different from the low-ratio group(51. 0%, P=0. 264). There was still a significant difference in the 30 d survival rate between the mediate and low-ratio group(75. 5% vs. 51. 0%, P=0. 011). Conclusion In severe hemorrhagic traumatic patients, as the FFP/PRBC ratio increases, the 24 h laboratory values are improved and the short-term survival rates ( 24 h ) increased. However, the risk of transfusion - related complication increases significantly when the FFP/PRBC ratio is raised to >1:1. So, 1:2<FFP/PRBC≤1:1 may be an optimal transfusion choice for severe traumatic hemorrhage.