crystalloid-to-blood ratio in severe hemorrhagic shock resuscitation

• Previous message: crystalloid-to-blood ratio in severe hemorrhagic shock resuscitation
• Next message: crystalloid-to-blood ratio in severe hemorrhagic shock resuscitation
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

 Crystalloid Resuscitation Improves Survival in Trauma Patients Receiving
Low Ratios of Fresh Frozen Plasma to Packed Red Blood Cells Spoerke,
Nicholas MD; Michalek, Joel PhD; Schreiber, Martin MD, FACS; the Trauma
Outcomes Group

Background: Current trauma resuscitation guidelines recommend giving an
initial crystalloid bolus as first line for resuscitation. Recent studies
have shown a survival benefit for trauma patients resuscitated with high
ratios of fresh frozen plasma (FFP) to packed red blood cells (PRBC). Our
aim was to determine whether the volume of crystalloid given during
resuscitation correlated with differences in morbidity or mortality based on
the ratio of FFP:PRBC given.

Methods: This was a retrospective review of 2,473 transfused trauma patients
at 23 Level I trauma centers from July 2005 to October 2007. Patients were
separated based on the ratios of FFP:PRBC they received (<1:4, 1:4–1:1, and
>1:1) and then analyzed for morbidity and mortality based on whether or not
they received at least 1 L crystalloid for each unit of PRBC. Outcomes
analyzed were 6-hour, 24-hour, and 30-day survival as well as intensive care
unit (ICU)-free days, ventilator-free days, and hospital-free days.

Results: Massive transfusion patients who received <1:4 ratios of FFP:PRBC
had significantly improved 6-hour, 24-hour, and 30-day mortality and
significantly more ventilator-free days if they received at least 1 L of
crystalloid for each unit of PRBC. Nonmassive transfusion patients who
received <1:4 ratios of FFP:PRBC had significantly improved 6-hour, 24-hour,
and 30-day mortality and significantly more ICU-free days, ventilator-free
days, and hospital-free days if they received at least 1 L crystalloid for
each unit of PRBC. In both massive and nonmassive transfusion groups, the
survival benefit and morbidity benefit was progressively less for the 1:4 to
1:1 FFP:PRBC groups and >1:1 FFP:PRBC groups.

Conclusions: If high ratios of FFP:PRBC are unable to be given to trauma
patients, resuscitation with at least 1 L of crystalloid per unit of PRBC is
associated with improved overall mortality.

• Previous message: crystalloid-to-blood ratio in severe hemorrhagic shock resuscitation
• Next message: crystalloid-to-blood ratio in severe hemorrhagic shock resuscitation
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]