Topic: B. Clinical Burns/Trauma
Early Aggressive Use of Fresh Frozen Plasma (FFP) Does Not Improve Outcome in Critically Injured Trauma Patients
Thomas Scalea, Grant Bochicchio, Kim Lumpkins, John Hess, Richard Dutton, Anne Pyle, Kelly Bochicchio
University of Maryland, Baltimore, MD
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 ICU 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 APACHE 2 score, to determine if early aggressive use of PRBC:FFP improved outcome.
Results: 77% of patients were male (N= 617) and 85% sustained blunt injury (n= 680). Mean age, 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, 6 and 5 ± 12 U respectively. 365 (45%) patients were transfused in the first 24 hours. 68% (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 ICU days, hospital days or mortality even in patients who received massive transfusion (≥ 10U). 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 to military injury, however this practice should be re-evaluated.