Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients

John B. Holcomb, Charles E. Wade, Joel E. Michalek, Gary B. Chisholm, Lee Ann Zarzabal, Martin Schreiber, Ernest A. Gonzalez, Gregory J. Pomper, Jeremy G. Perkins, Phillip C. Spinella, Kari L. Williams, Myung S. Park

    Research output: Contribution to journalArticle

    730 Citations (Scopus)

    Abstract

    Objective: To determine the effect of blood component ratios in massive transfusion (MT), we hypothesized that increased use of plasma and platelet to red blood cell (RBC) ratios would result in decreased early hemorrhagic death and this benefit would be sustained over the ensuing hospitalization. Summary Background Data: Civilian guidelines for massive transfusion (MT≥ 10 units of RBC in 24 hours) have typically recommend a 1:3 ratio of plasma:RBC, whereas optimal platelet:RBC ratios are unknown. Conversely, military data shows that a plasma:RBC ratio approaching 1:1 improves long term outcomes in MT combat casualties. There is little consensus on optimal platelet transfusions in either civilian or military practice. At present, the optimal combinations of plasma, platelet, and RBCs for MT in civilian patients is unclear. Methods: Records of 467 MT trauma patients transported from the scene to 16 level 1 trauma centers between July 2005 and June 2006 were reviewed. One patient who died within 30 minutes of admission was excluded. Based on high and low plasma and platelet to RBC ratios, 4 groups were analyzed. Results: Among 466 MT patients, survival varied by center from 41% to 74%. Mean injury severity score varied by center from 22 to 40; the average of the center means was 33. The plasma:RBC ratio ranged from 0 to 2.89 (mean ± SD: 0.56 ± 0.35) and the platelets:RBC ratio ranged from 0 to 2.5 (0.55 ± 0.50). Plasma and platelet to RBC ratios and injury severity score were predictors of death at 6 hours, 24 hours, and 30 days in multivariate logistic models. Thirty-day survival was increased in patients with high plasma:RBC ratio (≥1:2) relative to those with low plasma:RBC ratio (

    Original languageEnglish (US)
    Pages (from-to)447-456
    Number of pages10
    JournalAnnals of Surgery
    Volume248
    Issue number3
    DOIs
    StatePublished - Sep 2008

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    Blood Platelets
    Erythrocytes
    Wounds and Injuries
    Injury Severity Score
    Platelet Transfusion
    Survival
    Trauma Centers
    Hospitalization
    Logistic Models
    Guidelines

    ASJC Scopus subject areas

    • Surgery

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    Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. / Holcomb, John B.; Wade, Charles E.; Michalek, Joel E.; Chisholm, Gary B.; Zarzabal, Lee Ann; Schreiber, Martin; Gonzalez, Ernest A.; Pomper, Gregory J.; Perkins, Jeremy G.; Spinella, Phillip C.; Williams, Kari L.; Park, Myung S.

    In: Annals of Surgery, Vol. 248, No. 3, 09.2008, p. 447-456.

    Research output: Contribution to journalArticle

    Holcomb, JB, Wade, CE, Michalek, JE, Chisholm, GB, Zarzabal, LA, Schreiber, M, Gonzalez, EA, Pomper, GJ, Perkins, JG, Spinella, PC, Williams, KL & Park, MS 2008, 'Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients', Annals of Surgery, vol. 248, no. 3, pp. 447-456. https://doi.org/10.1097/SLA.0b013e318185a9ad
    Holcomb, John B. ; Wade, Charles E. ; Michalek, Joel E. ; Chisholm, Gary B. ; Zarzabal, Lee Ann ; Schreiber, Martin ; Gonzalez, Ernest A. ; Pomper, Gregory J. ; Perkins, Jeremy G. ; Spinella, Phillip C. ; Williams, Kari L. ; Park, Myung S. / Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. In: Annals of Surgery. 2008 ; Vol. 248, No. 3. pp. 447-456.
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    abstract = "Objective: To determine the effect of blood component ratios in massive transfusion (MT), we hypothesized that increased use of plasma and platelet to red blood cell (RBC) ratios would result in decreased early hemorrhagic death and this benefit would be sustained over the ensuing hospitalization. Summary Background Data: Civilian guidelines for massive transfusion (MT≥ 10 units of RBC in 24 hours) have typically recommend a 1:3 ratio of plasma:RBC, whereas optimal platelet:RBC ratios are unknown. Conversely, military data shows that a plasma:RBC ratio approaching 1:1 improves long term outcomes in MT combat casualties. There is little consensus on optimal platelet transfusions in either civilian or military practice. At present, the optimal combinations of plasma, platelet, and RBCs for MT in civilian patients is unclear. Methods: Records of 467 MT trauma patients transported from the scene to 16 level 1 trauma centers between July 2005 and June 2006 were reviewed. One patient who died within 30 minutes of admission was excluded. Based on high and low plasma and platelet to RBC ratios, 4 groups were analyzed. Results: Among 466 MT patients, survival varied by center from 41{\%} to 74{\%}. Mean injury severity score varied by center from 22 to 40; the average of the center means was 33. The plasma:RBC ratio ranged from 0 to 2.89 (mean ± SD: 0.56 ± 0.35) and the platelets:RBC ratio ranged from 0 to 2.5 (0.55 ± 0.50). Plasma and platelet to RBC ratios and injury severity score were predictors of death at 6 hours, 24 hours, and 30 days in multivariate logistic models. Thirty-day survival was increased in patients with high plasma:RBC ratio (≥1:2) relative to those with low plasma:RBC ratio (",
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    T1 - Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients

    AU - Holcomb, John B.

    AU - Wade, Charles E.

    AU - Michalek, Joel E.

    AU - Chisholm, Gary B.

    AU - Zarzabal, Lee Ann

    AU - Schreiber, Martin

    AU - Gonzalez, Ernest A.

    AU - Pomper, Gregory J.

    AU - Perkins, Jeremy G.

    AU - Spinella, Phillip C.

    AU - Williams, Kari L.

    AU - Park, Myung S.

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    N2 - Objective: To determine the effect of blood component ratios in massive transfusion (MT), we hypothesized that increased use of plasma and platelet to red blood cell (RBC) ratios would result in decreased early hemorrhagic death and this benefit would be sustained over the ensuing hospitalization. Summary Background Data: Civilian guidelines for massive transfusion (MT≥ 10 units of RBC in 24 hours) have typically recommend a 1:3 ratio of plasma:RBC, whereas optimal platelet:RBC ratios are unknown. Conversely, military data shows that a plasma:RBC ratio approaching 1:1 improves long term outcomes in MT combat casualties. There is little consensus on optimal platelet transfusions in either civilian or military practice. At present, the optimal combinations of plasma, platelet, and RBCs for MT in civilian patients is unclear. Methods: Records of 467 MT trauma patients transported from the scene to 16 level 1 trauma centers between July 2005 and June 2006 were reviewed. One patient who died within 30 minutes of admission was excluded. Based on high and low plasma and platelet to RBC ratios, 4 groups were analyzed. Results: Among 466 MT patients, survival varied by center from 41% to 74%. Mean injury severity score varied by center from 22 to 40; the average of the center means was 33. The plasma:RBC ratio ranged from 0 to 2.89 (mean ± SD: 0.56 ± 0.35) and the platelets:RBC ratio ranged from 0 to 2.5 (0.55 ± 0.50). Plasma and platelet to RBC ratios and injury severity score were predictors of death at 6 hours, 24 hours, and 30 days in multivariate logistic models. Thirty-day survival was increased in patients with high plasma:RBC ratio (≥1:2) relative to those with low plasma:RBC ratio (

    AB - Objective: To determine the effect of blood component ratios in massive transfusion (MT), we hypothesized that increased use of plasma and platelet to red blood cell (RBC) ratios would result in decreased early hemorrhagic death and this benefit would be sustained over the ensuing hospitalization. Summary Background Data: Civilian guidelines for massive transfusion (MT≥ 10 units of RBC in 24 hours) have typically recommend a 1:3 ratio of plasma:RBC, whereas optimal platelet:RBC ratios are unknown. Conversely, military data shows that a plasma:RBC ratio approaching 1:1 improves long term outcomes in MT combat casualties. There is little consensus on optimal platelet transfusions in either civilian or military practice. At present, the optimal combinations of plasma, platelet, and RBCs for MT in civilian patients is unclear. Methods: Records of 467 MT trauma patients transported from the scene to 16 level 1 trauma centers between July 2005 and June 2006 were reviewed. One patient who died within 30 minutes of admission was excluded. Based on high and low plasma and platelet to RBC ratios, 4 groups were analyzed. Results: Among 466 MT patients, survival varied by center from 41% to 74%. Mean injury severity score varied by center from 22 to 40; the average of the center means was 33. The plasma:RBC ratio ranged from 0 to 2.89 (mean ± SD: 0.56 ± 0.35) and the platelets:RBC ratio ranged from 0 to 2.5 (0.55 ± 0.50). Plasma and platelet to RBC ratios and injury severity score were predictors of death at 6 hours, 24 hours, and 30 days in multivariate logistic models. Thirty-day survival was increased in patients with high plasma:RBC ratio (≥1:2) relative to those with low plasma:RBC ratio (

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