Tim Rijnhout (Leiderdorp / NL; Rotterdam / NL), Femke Noorman (Utrecht / NL), Edward Tan (Nijmegen / NL), Victor Viersen (Amsterdam / NL), Boudewijn Borger van der Burg (Leiderdorp / NL), Michaëla van Bohemen (Rotterdam / NL), Oscar van Waes (Rotterdam / NL), Michael H.J. Verhofstad (Rotterdam / NL), Rigo Hoencamp (Leiderdorp / NL; Rotterdam / NL; Utrecht / NL; Leiden / NL)
Abstract text (incl. references and figure legends)
Introduction
The optimal transfusion ratio of platelets (PLT), plasma and red blood cells (RBC) in trauma patients with massive hemorrhage is still a subject of discussion. The objective of this study is to assess the effect of platelet transfusion on mortality in trauma patients who received massive transfusion.
Material & Methods
Data were collected from four Dutch level-1 trauma centers. All trauma patients aged ≥ 16 years who were admitted and received ≥ 6 RBC / 6 hours or ≥ 10 RBC / 24 hours from the time of injury were included. Patients were divided based on platelet to RBC ratio (no platelets, low (<1:5) and high (≥1:5)) and plasma:RBC ratio (low (<1:1) and high (≥1:1).
Results
A total of 297 patients were included. Patients in the high PLT ratio group had lower mortality rates at six hours as compared to the low PLT ratio and no PLT group (9% vs. 26% vs. 32%, p=.002). The odds ratios (OR) for survival beyond six-hours were 0.970 (95% CI 0.951-0.991) for the injury severity score, 2.4 (95% CI 1.22-4.81) for in hospital use of fibrinogen concentrate and 6.14 (95% CI 1.88-20.45) for plasma:RBC ratio of 1:1. Sub analysis of 229 (77%) patients with blunt injury showed that a plasma:RBC ratio of ≥1:1 resulted in a survival benefit at all studied time intervals.
Conclusions
Trauma patients who received massive transfusion with a PLT:RBC ratio of ≥ 1:5 had lower mortality at six hours as compared to a PLT:RBC ratio of < 1:5 or no platelets. Additionally, a plasma:RBC ratio of ≥ 1:1 and in hospital use of fibrinogen concentrate were associated with lower mortality rates at six hours. For patients with blunt injury, a plasma:RBC ratio of ≥1:1 was associated with lower mortality rates at all studied time intervals as compared to lower plasma:RBC ratios.
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