A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study

Am J Surg. 2009 May;197(5):565-70; discussion 570. doi: 10.1016/j.amjsurg.2008.12.014.


Background: In trauma, most hemorrhagic deaths occur within the first 6 hours. This study examined the effect on survival of high ratios of fresh frozen plasma (FFP) and platelets (PLTs) to packed red blood cells (PRBCs) in the first 6 hours.

Methods: Records of 466 massive transfusion trauma patients (>or=10 U of PRBCs in 24 hours) at 16 level 1 trauma centers were reviewed. Transfusion ratios in the first 6 hours were correlated with outcome.

Results: All groups had similar baseline characteristics. Higher 6-hour ratios of FFP:PRBCs and PLTs:PRBCs lead to improved 6-hour mortality (from 37.3 [in the lowest ratio group] to 15.7 [in the middle ratio group] to 2.0% [in the highest ratio group] and 22.8% to 19.0% to 3.2%, respectively) and in-hospital mortality (from 54.9 to 41.1 to 25.5% and 43.7% to 46.8% to 27.4%, respectively). Initial higher ratios of FFP:PRBCs and PLTs:PRBCs decreased overall PRBC transfusion.

Conclusions: The early administration of high ratios of FFP and platelets improves survival and decreases overall PRBC need in massively transfused patients. The largest difference in mortality occurs during the first 6 hours after admission, suggesting that the early administration of FFP and platelets is critical.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Lung Injury / epidemiology
  • Blood Component Transfusion / adverse effects
  • Blood Component Transfusion / mortality*
  • Blood Component Transfusion / statistics & numerical data
  • Blood Platelets
  • Blood Transfusion
  • Erythrocyte Transfusion / mortality
  • Hospital Mortality
  • Humans
  • Plasma
  • Retrospective Studies
  • Shock, Hemorrhagic / mortality*
  • Trauma Centers
  • Wounds and Injuries / mortality*