Massive transfusion ratios commonly used in trauma settings might not be appropriate for nontrauma patients, a retrospective analysis suggests.
“High-ratio blood component to blood therapy has been a lifesaving intervention for massively bleeding trauma patients experiencing trauma-induced coagulopathy (TIC),” Dr. Matthew D. Neal from the University of Pittsburgh School of Medicine in Pennsylvania told Reuters Health by email. “However, patients who have massive bleeding from other, non-trauma sources, may be very different. If their physiology and coagulopathy are different, the resuscitation strategy may need to be as well.”
Based on evidence linking the delivery of high ratios of plasma and platelet to red blood cells with improved survival in military and civilian trauma populations, similar protocols have been used for nontrauma patients. There is, however, a lack of convincing data supporting the ideal ratio of transfusion in the nontrauma setting, according to Dr. Neal and colleagues.
The team examined the impact of massive transfusion with relatively higher (>1:2) or lower (<=1:2) ratios of fresh frozen plasma (FFP)-to-packed RBCs (PRBC) and platelets-to-PRBC on 30-day mortality in 601 nontrauma patients.
FFP-to-PRBC ratio was not associated with 48-hour mortality, 30-day mortality, posttransfusion hospital length of stay, ICU days, or ventilator-free days, the researchers report in Critical Care Medicine, online May 23.
A high ratio of platelets-to-PRBC was associated with significantly decreased 48-hour mortality (10.5% with high ratios vs. 19.3% with low ratios), but not 30-day mortality, posttransfusion hospital length of stay, ICU days, or ventilator-free days.
“It is hard to extrapolate management decisions based on a retrospective study,” Dr. Neal said. “However, I think that clinicians need to be aware that the jury is still out as to the best resuscitation strategy for nontrauma patients. The best strategy is likely a personalized, goal-directed approach, but until we define this prospectively, we should be aware that data derived from trauma based massive transfusion may not be perfectly applicable to all bleeding patients.”
Dr. Jed B. Gorlin from Innovative Blood Resources, Hennepin County Medical Center, in St. Paul, Minnesota, who has also expressed concerns over the lack of evidence supporting a one-size-fits-all massive transfusion protocol, told Reuters Health by email, “Worry less about the exact ratio and more about having a well-defined communication plan for prompt delivery of products in emergent transfusion. It is probably wise to try various combinations and carefully record outcomes so we can continue to learn which variables actually matter.”
Dr. Jose Antonio Garcia Erce, director of the blood and tissue bank at the University of Navarra, in Pamplona, Spain, who was not involved in the research, noted that a recent study found that “every hospital has its own massive transfusion protocol. All different and none validated in all situations.”
He told Reuters Health by email, “Medicine must be individualized. Focus on the patient and the objectives, with the best weapons to diagnose (close, rapid, and sensitive) and to reverse specifically coagulopathy, hyperfibrinolysis, thrombocytopenia, or thrombocytopathy.”