Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients?

Frederick A. Moore, Teresa Nelson, Bruce A. McKinley, Ernest E. Moore, Avery B. Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J. Beilman, Stephen M. Cohn

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Background: Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding. Methods: To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective traumatic shock database of 383 civilians. Results: Ninety-three (24%) of the traumatic shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated. Conclusion: Civilians who arrived in traumatic shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.

Original languageEnglish (US)
Pages (from-to)948-960
Number of pages13
JournalAmerican journal of surgery
Volume196
Issue number6
DOIs
StatePublished - Dec 1 2008

Keywords

  • Coagulopathy
  • Massive transfusion
  • Multiple organ failure
  • StO
  • Tissue hemoglobin oxygen saturation
  • Traumatic shock

ASJC Scopus subject areas

  • Surgery

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    Moore, F. A., Nelson, T., McKinley, B. A., Moore, E. E., Nathens, A. B., Rhee, P., Puyana, J. C., Beilman, G. J., & Cohn, S. M. (2008). Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients? American journal of surgery, 196(6), 948-960. https://doi.org/10.1016/j.amjsurg.2008.07.043