High ratio of plasma to red cells in contemporary resuscitation of haemorrhagic shock after trauma: a secondary analysis of the PATCH-trauma trial.

IF 3.1 2区医学 Q1 EMERGENCY MEDICINE

Scandinavian Journal of Trauma Resuscitation & Emergency Medicine Pub Date : 2025-10-02 DOI:10.1186/s13049-025-01476-2

Biswadev Mitra, Michael C Reade, Steve Bernard, Bridget Dicker, Marc Maegele, Russell L Gruen

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Abstract

Background: Plasma transfusion is recommended as an initial intervention in most major haemorrhage protocols for trauma resuscitation. With availability of newer blood components, therapeutic agents and investigations for coagulopathy, the marginal benefits of high ratios of plasma to red cells is uncertain. The aim of this study was to report the association of high ratios of plasma: red cells and 28-day mortality in patients with major trauma.

Methods: The PATCH-Trauma trial enrolled critically bleeding patients at high risk of trauma induced coagulopathy and randomised them to receive prehospital tranexamic acid or placebo. The sub-group of patients who were managed with massive transfusions in hospital (> 4 units of red cells in first 4 h) were included for this post-hoc analysis. Associations of high ratios of plasma (more than 1 unit of plasma for every 2 units of red cells) and 28-day mortality were reported using multivariable logistic regression analysis after adjustment for potential confounders including age, neurological injury, injury severity, coagulopathy and administration of platelets, fibrinogen concentrates, cryoprecipitate and tranexamic acid.

Results: Among 1310 patients enrolled in the PATCH-trauma trial, 372 patients were included for this analysis; 213 (57.3%) received high ratios of plasma: red cells and 116 (31.4%) deaths were recorded at 28 days. High ratios of plasma: red cells were associated with lower mortality (adjusted odds ratio; aOR 0.50; 95%CI: 0.26-0.96). Older age (aOR 1.02; 95%CI: 1.01-1.03), initial Glasgow Coma Scale 3-8 (aOR 6.57; 95%CI: 2.92-14.80) and trauma induced coagulopathy (aOR 5.64; 95%CI: 2.87-11.1) on hospital arrival were associated with higher mortality.

Conclusions: Among patients with critical bleeding managed with massive transfusions, high ratios of plasma: red cells were associated with lower mortality, after controlling for potential confounders. Ongoing provision of early plasma for management of critical bleeding is indicated with consideration to prehospital plasma.

Registration: ClinicalTrials.gov number, NCT02187120 (Registered 09 July 2014).

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血浆与红细胞在当代创伤后失血性休克复苏中的高比率：对patch -创伤试验的二次分析。

背景：在大多数创伤复苏的主要出血方案中，血浆输血被推荐作为初始干预措施。随着新的血液成分、治疗药物和对凝血病的研究的出现，高血浆与红细胞比例的边际效益尚不确定。本研究的目的是报道严重创伤患者血浆：红细胞的高比率与28天死亡率之间的关系。方法：PATCH-Trauma试验招募了创伤性凝血功能障碍高风险的重症出血患者，并将他们随机分为院前氨甲环酸组和安慰剂组。这项事后分析包括在医院大量输血（头4小时输血4个单位）的患者亚组。在校正潜在混杂因素（包括年龄、神经损伤、损伤严重程度、凝血功能障碍和血小板、纤维蛋白原浓液、低温沉淀和氨甲环酸）后，使用多变量logistic回归分析报告了高血浆比率（每2单位红细胞超过1单位血浆）与28天死亡率的关联。结果：在1310例入组PATCH-trauma试验的患者中，372例患者被纳入本分析；213例（57.3%）接受了高比例的血浆：红细胞，116例（31.4%）在28天死亡。血浆：红细胞的高比例与较低的死亡率相关（校正优势比；aOR 0.50; 95%CI: 0.26-0.96）。入院时年龄较大（aOR 1.02; 95%CI: 1.01-1.03）、初始格拉斯哥昏迷量表3-8 （aOR 6.57; 95%CI: 2.92-14.80）和创伤性凝血功能障碍（aOR 5.64; 95%CI: 2.87-11.1）与较高的死亡率相关。结论：在大量输血治疗的重症出血患者中，在控制了潜在的混杂因素后，血浆：红细胞的高比例与较低的死亡率相关。在考虑院前血浆的情况下，持续提供早期血浆治疗危重出血。注册：ClinicalTrials.gov号码：NCT02187120（注册于2014年7月9日）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scandinavian Journal of Trauma Resuscitation & Emergency Medicine EMERGENCY MEDICINE-

CiteScore

6.10

自引率

6.10%

发文量

审稿时长

6-12 weeks

期刊介绍： The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.