The association of blood component use ratios with the survival of massively transfused trauma patients with and without severe brain injury

Philip C. Spinella, Charles E. Wade, Lorne H. Blackbourne, Matthew A. Borgman, Lee A. Zarzabal, Fei Du, Jeremy G. Perkins, Marc Maegele, Martin Schreiber, John R. Hess, Kenneth M. Jastrow, Ernest A. Gonzalez, John B. Holcomb, Rosemary Kozar, Trauma Outcomes Group The Trauma Outcomes Group

    Research output: Contribution to journalArticle

    55 Scopus citations

    Abstract

    Background: The effect of blood component ratios on the survival of patients with traumatic brain injury (TBI) has not been studied. Methods: A database of patients transfused in the first 24 hours after admission for injury from 22 Level I trauma centers over an 18-month period was queried to find patients who (1) met different definitions of massive transfusion (5 units red blood cell [RBC] in 6 hours vs. 10 units RBC in 24 hours), (2) received high or low ratios of platelets or plasma to RBC units (<1:2 vs. ≥1:2), and (3) had severe TBI (head abbreviated injury score ≥3) (TBI+). Results: Of 2,312 total patients, 850 patients were transfused with ≥5 RBC units in 6 hours and 807 could be classified into TBI+ (n = 281) or TBI- (n = 526). Six hundred forty-three patients were transfused with ≥10 RBC units in 24 hours with 622 classified into TBI+ (n = 220) and TBI- (n = 402). For both high-risk populations, a high ratio of platelets:RBCs (not plasma) was independently associated with improved 30-day survival for patients with TBI+ and a high ratio of plasma:RBCs (not platelets) was independently associated with improved 30-day survival in TBI- patients. Conclusions: High platelet ratio was associated with improved survival in TBI+ patients while a high plasma ratio was associated with improved survival in TBI- patients. Prospective studies of blood product ratios should include TBI in the analysis for determination of optimal use of ratios on outcome in injured patients.

    Original languageEnglish (US)
    Pages (from-to)S343-S352
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume71
    Issue number2 SUPPL. 3
    DOIs
    StatePublished - Aug 1 2011

    Keywords

    • Mortality
    • Plasma
    • Platelets
    • Red Blood Cell
    • Transfusion

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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    Spinella, P. C., Wade, C. E., Blackbourne, L. H., Borgman, M. A., Zarzabal, L. A., Du, F., Perkins, J. G., Maegele, M., Schreiber, M., Hess, J. R., Jastrow, K. M., Gonzalez, E. A., Holcomb, J. B., Kozar, R., & The Trauma Outcomes Group, T. O. G. (2011). The association of blood component use ratios with the survival of massively transfused trauma patients with and without severe brain injury. Journal of Trauma - Injury, Infection and Critical Care, 71(2 SUPPL. 3), S343-S352. https://doi.org/10.1097/TA.0b013e318227ef2d