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Early Aggressive Use of Fresh Frozen Plasma Does Not Improve Outcome in Critically Injured Trauma Patients

Scalea, Thomas M. MD; Bochicchio, Kelly M. RN, BSN, MS; Lumpkins, Kim MD; Hess, John R. MD, MPH; Dutton, Richard MD; Pyle, Anne RN, BSN, MS; Bochicchio, Grant V. MD, MPH

Annals of Surgery:
doi: 10.1097/SLA.0b013e31818990ed
Original Articles
Abstract

Objectives: Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy.

Methods: Prospective data were collected on 806 consecutive trauma patients admitted to the intensive care unit over 2 years. Patients were stratified by PRBC:FFP transfusion ratio over the first 24 hours. Stepwise regression models were performed controlling for age, gender, mechanism of injury, injury severity, and acute physiology and chronic health evaluation (APACHE) 2 score to determine if early aggressive use of PRBC:FFP improved outcome.

Results: Seventy-seven percent of patients were male (N = 617) and 85% sustained blunt injury (n = 680). Mean age, injury severity score (ISS), and APACHE score were 43 ± 20 years, 29 ± 13, and 13 ± 7, respectively. Mean number of PRBCs and FFP transfused were 7.7 ± 12 U, 6 U, and 5 ± 12 U, respectively. Three hundred sixty-five (45%) patients were transfused in the first 24 hours. Sixty-eight percent (n = 250) of them received both PRBCs and FFP. Analyzing these patients by stepwise regression controlling for all significant variables, the PRBC:FFP ratio did not predict intensive care unit days, hospital days, or mortality even in patients who received massive transfusion (≥10 U). Furthermore, there was no significant difference in outcome when comparing patients who had a 1:1 PRBC:FFP ratio with those who did not receive any FFP.

Conclusion: Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.

In Brief

Recent data from Iraq supporting early aggressive use of fresh frozen plasma in a 1:1 ratio to packed red blood cells has led many civilian trauma centers to adopt this resource intensive strategy. However, early and aggressive use of fresh frozen plasma does not improve outcome after civilian injury. This may reflect inherent differences compared to military injury; however, this practice should be reevaluated.

Author Information

From the R Adams Cowley Shock Trauma Center, Division of Clinical and Outcomes Research, Departments of Surgery, Anesthesiology, and Pathology, University of Maryland School of Medicine, Baltimore, MD.

Partial funding was provided by NIH Grant 1T32GM075767.

Reprints: Thomas M. Scalea, MD, Room T3R32, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201. E-mail: tscalea@umm.edu.

© 2008 Lippincott Williams & Wilkins, Inc.