Holcomb JB, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008 Sep;248(3):447-58.
Several recent retrospective studies addressed this question, but this one had
- A well-defined population: adult trauma patients at multiple level 1 trauma centers, who arrived from the scene and received at least 1 unit of RBC in the ED, July 2005-June 2006
- Similarity in baseline characteristics of the groups (mean INR, pH, injury severity scores, age, admission platelet counts) except for mean admission systolic blood pressure
Short answer: Survival in massive transfusion patients is associated with increased plasma and platelet ratios.
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. Outcomes were 6 hour, 24 hours and 30 day mortality.
Figure 2 compares the 24 hour survival by 4 groups by transfusion ratios: high FFP & high platelets to RBCs, high FFP & low platelets to RBCs, low FFP & high platelets to RBCs, and low FFP & low platelets to RBCs.
Table 4 includes a comparison of the groups by cause of death. The group receiving the high ratio of FFP & high ratio of platelets to RBCs had the smallest rate of death by truncal hemorrhage.