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Acute lung injury after ruptured abdominal aortic aneurysm repair: The effect of excluding donations from females from the production of fresh frozen plasma*

Wright, Stephen E. MB ChB, MRCP, FRCA; Snowden, Christopher P. MD, FRCA; Athey, Sally C. MB BS, MRCS, FRCR; Leaver, Alice A. MB ChB, BSc (Hons), MPhil, FRCR; Clarkson, Jill-Marie MB BS; Chapman, Catherine E. MD, FRCP, FRCPath; Roberts, David R. D. BSc, MB ChB, FRCA; Wallis, Jonathan P. MB BS, FRCP, FRCPath

doi: 10.1097/CCM.0b013e3181743c6e
Clinical Investigations
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Objectives: Transfusion-related acute lung injury may contribute to the development of acute lung injury in the critically ill, due to plasma from female donors containing antileukocyte antibodies. In July 2003, the U.K. National Blood Service stopped using female donor plasma for the production of fresh frozen plasma. Patients undergoing repair of a ruptured abdominal aortic aneurysm receive large amounts of fresh frozen plasma and often develop acute lung injury. We investigated whether the change to male fresh frozen plasma was associated with a change in the frequency of acute lung injury in these patients.

Design: A retrospective, before and after, observational, single-center study.

Setting: Tertiary care center and a regional blood center.

Patients: The study included 211 patients undergoing open repair of a ruptured abdominal aortic aneurysm between 1998 and 2006.

Interventions: None.

Measurements and Main Results: Primary outcome was the development of acute lung injury in the first 6 hrs after surgery. Secondary outcomes were significant hypoxia (Pao2/Fio2 ratio <300), time to extubation, and survival at 30 days. Groups were well matched and received similar volumes of intravenous fluids and blood components. There was significantly less acute lung injury following the change to male fresh frozen plasma (36% before vs. 21% after, p = .04). At 6 hrs after surgery, fewer patients were hypoxic (87% before vs. 62% after, p < .01). In multivariate analysis, the change in donor policy was associated with a decreased risk of developing acute lung injury (odds ratio 0.39; 95% confidence interval, 0.16–0.90). Time to extubation and survival at 30 days were not statistically different between groups.

Conclusions: The policy to exclude female donors from the production of fresh frozen plasma was associated with a decrease in the frequency of acute lung injury in patients undergoing repair of a ruptured abdominal aortic aneurysm.

From the Department of Perioperative and Critical Care (SEW, CPS, DRDR), Department of Radiology (SCA, AAL), and Department of Haematology (JPW), Freeman Hospital, Newcastle upon Tyne, United Kingdom; and the National Blood Service, Newcastle upon Tyne, United Kingdom (JMC, CEC).

Supported, in part, by a grant from the Newcastle upon Tyne Hospitals NHS Charity (Research and Development Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom) and by departmental funds of the Department of Haematology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.

Presented, in part, at the 27th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, March 27, 2007. Abstract appeared in Crit Care 2007; 11(Suppl 2):S150 (Poster 374).

For information regarding this article, E-mail: s.e.wright@dsl.pipex.com

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins