Sat., 10/16/10 Polytrauma & Femur, Paper #68, 10:29 am OTA-2010
A High Ratio of Fresh Frozen Plasma to Packed Red Blood Cells Significantly Decreases Mortality in Femur Fracture Patients Requiring Massive Transfusion
Justin Michael Broyles, BS; Gavin Wagenheim, BBA; Sartaj Alam, MS;
Catherine Ambrose, PhD; Milan Sen, MD;
The University of Texas Health Science Center at Houston, Houston, Texas, USA
Purpose: This study was designed to evaluate new treatment modalities in the management of the severely injured polytrauma patient. Specifically, we evaluated the outcomes of two populations of femur fracture patients requiring massive transfusions: a population who received packed red blood cells (PRBC) only, and a population who received a 1:1 ratio of fresh-frozen plasma (FFP) to PRBC. The hypothesis was that a 1:1 FFP:PRBC ratio will improve survival in this selected patient population.
Methods: Excluding patients under the age of 18 years, 1594 consecutive blunt trauma patients were admitted to our trauma center and diagnosed with one or more femur fractures during a 100-month period from September 1, 1999 to December 31, 2007. This large cohort of orthopaedic fractures was retrospectively examined for patients who only received massive transfusions, and only 161 of these patients met the criteria to be included in our study. We defined a massive transfusion as 10 or more units of PRBC within a 24-hour period. The 1:1 FFP:PRBC massive transfusion protocol was implemented July 1, 2005. Retrospectively, these patients were divided into two cohorts: group I consisted of 101 patients who presented to the emergency department between September 1, 1999 and June 30, 2005, and group II consisted of 61 patients who presented to the emergency department between July 1, 2005 and December 31, 2007. Group I received only PRBC initially and coagulation parameters were later corrected with FFP, but never in an initial 1:1 FFP:PRBC ratio. Group II received 1:1 FFP:PRBC transfusions from the start of transfusion.
Results: Patients in group I did not differ significantly with regards to age, sex, race, surgical treatment modality, or injury severity score (ISS) when compared to group II. In group I, 41.5% of patients died despite treatment. Of the patients in group II, only 22.9% died. This difference was significant (P < 0.01).
Conclusion: The implementation of a 1:1 FFP:PRBC product ratio in patients with fractures of the femur requiring massive transfusion significantly decreases mortality when compared to lower FFP:PRBC product ratios.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.