Investigating the association between initial blood product transfusion with a higher plasma-to-red blood cell ratio and mortality in adults with severe bleeding following trauma.

Abstract

Objective: Trauma patients presenting with massive bleeding require significant blood transfusions to restore circulation and achieve hemostasis. The ratio of fresh-frozen plasma (FFP) to packed red blood cells (PRBC) is critical in determining immediate outcomes and mortality in these patients. This study aims to evaluate the impact of a high FFP:PRBC ratio on 24-hour and 30-day mortality among trauma patients with massive bleeding.

Methods: In this retrospective descriptive study, inclusion criteria involved adults aged 18 or older presenting with massive trauma-related bleeding within 6 hours after trauma. Patients were categorized into two groups based on the FFP:PRBC ratio: high ratio (>1:1.5) or low ratio (<1:1.5) for damage control resuscitation. Data on demographic characteristics, mortality, intensive care unit (ICU) admission, length of hospital stay, and need for mechanical ventilation were collected. The primary outcomes were 24-hour and 30-day mortality, while secondary outcomes included ICU admission, mechanical ventilation duration, and hospital stay length. A Chi-square test was used to evaluate the association betweena high FFP:PRBC ratio and 24-hour and 30-day mortality. The Mann-Whitney test was used to analyze secondary outcomes.

Results: Among 300 patients with a mean age of 40.5 years, 231 (76.7%) were male, and 69 (22.9%) were female. The high FFP:PRBC ratio group showed significantly higher rates of 24-hour mortality (11.5%), 30-day mortality (45.9%), and ICU admission (P < 0.001). However, the mean duration of mechanical ventilation in the high ratio group was 3.36 ± 2.85 days, indicating that some patients in this group still required ventilatory support.

Conclusion: This study demonstrates that a high FFP:PRBC ratio (>1:1.5) is associated with reduced 24-hour and 30-day mortality rates among trauma patients with massive hemorrhage. However, the need for mechanical ventilation in some high-ratio patients suggests potential trade-offs that warrant further investigation. Additional research is needed to explore the potential adverse effects of high FFP:PRBC ratios and to optimize transfusion strategies in trauma care.