A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study

Karen A. Zink, Chitra N. Sambasivan, John B. Holcomb, Gary Chisholm, Martin A. Schreiber

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    261 Scopus citations


    Background: In trauma, most hemorrhagic deaths occur within the first 6 hours. This study examined the effect on survival of high ratios of fresh frozen plasma (FFP) and platelets (PLTs) to packed red blood cells (PRBCs) in the first 6 hours. Methods: Records of 466 massive transfusion trauma patients (≥10 U of PRBCs in 24 hours) at 16 level 1 trauma centers were reviewed. Transfusion ratios in the first 6 hours were correlated with outcome. Results: All groups had similar baseline characteristics. Higher 6-hour ratios of FFP:PRBCs and PLTs:PRBCs lead to improved 6-hour mortality (from 37.3 [in the lowest ratio group] to 15.7 [in the middle ratio group] to 2.0% [in the highest ratio group] and 22.8% to 19.0% to 3.2%, respectively) and in-hospital mortality (from 54.9 to 41.1 to 25.5% and 43.7% to 46.8% to 27.4%, respectively). Initial higher ratios of FFP:PRBCs and PLTs:PRBCs decreased overall PRBC transfusion. Conclusions: The early administration of high ratios of FFP and platelets improves survival and decreases overall PRBC need in massively transfused patients. The largest difference in mortality occurs during the first 6 hours after admission, suggesting that the early administration of FFP and platelets is critical.

    Original languageEnglish (US)
    Pages (from-to)565-570
    Number of pages6
    JournalAmerican journal of surgery
    Issue number5
    StatePublished - May 1 2009



    • Coagulopathy of trauma
    • Hemorrhagic shock
    • Massive transfusion
    • Transfusion ratios
    • Traumatic hemorrhage

    ASJC Scopus subject areas

    • Surgery

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