Trauma resuscitation requiring massive transfusion: A descriptive analysis of the role of ratio and time

Objective: We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP). Methods: A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥ 18years old) who received MTP (≥ 10 units) of packed red blood cell (PRBC) during the initial 24h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4h post-injury and also between (>4 and 24h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well. Results: During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30days (36 vs. 13 cases). The majority of deaths occurred within the first 24h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6h (55 vs. 46 %). Conclusions: Aggressive attainment of high FFP/PRBC ratios as early as 4h post-injury can substantially improve outcomes in trauma patients.