The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis

E. Bui, K. Inaba, A. Ebadat, E. Karamanos, S. Byerly, O. Okoye, I. Shulman, P. Rhee, D. Demetriades

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: Transfusion ratios approaching 1:1 FFP:PRBC for trauma resuscitation have become the de facto standard of care. The aim of this study was to prospectively evaluate the effect of increasing ratios of FFP:PRBC transfusion on survival for massively transfused civilian trauma patients as well as determine if time to reach the target ratio had any effect on outcomes. Methods: This is a prospective, observational study of all trauma patients requiring a massive transfusion (≥10 PRBC in ≤24 h) at a level 1 trauma center over a 2.5-year period. The ratio of FFP:PRBC was tracked hourly up to 24 h post-initiation of massive transfusion. A logistic regression model was utilized to identify the ideal ratio associated with mortality prediction. A stepwise logistic regression was performed to identify independent predictors of mortality. Results: The study population was predominantly male (89 %) with a mean age of 34.8 ± 16. On admission, 22 % had a systolic blood pressure ≤90 mmHg, 47 % had a heart rate ≥120, and 25 % had a GCS ≤8. The overall mortality was 33 %. The ratio of FFP:PRBC ≥ 1:1.5 was the second most important independent predictor of mortality for this population (R2 = 0.59). Survivors had a higher FFP:PRBC ratio at all times during the first 24 h of resuscitation. Conclusions: Achieving a ratio of FFP:PRBC ≥ 1:1.5 after the initial 24 h of resuscitation significantly improves survival in massively transfused trauma patients compared to patients that achieved a ratio <1:1.5.

Original languageEnglish (US)
Pages (from-to)519-525
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number4
StatePublished - Aug 1 2016


  • Hemorrhage
  • Massive transfusion
  • Resuscitation
  • Transfusion ratio
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine


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