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. 2015 Aug 14;10:36.
doi: 10.1186/s13017-015-0028-3. eCollection 2015.

Trauma Resuscitation Requiring Massive Transfusion: A Descriptive Analysis of the Role of Ratio and Time

Free PMC article

Trauma Resuscitation Requiring Massive Transfusion: A Descriptive Analysis of the Role of Ratio and Time

Ruben Peralta et al. World J Emerg Surg. .
Free PMC article


Objective: We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).

Methods: A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.

Results: During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %).

Conclusions: Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.

Keywords: Massive transfusion protocol; Outcome; Transfusion ratio; Trauma.


Fig. 1
Fig. 1
Distribution of infectious complications according to FFP: PRBC ratios
Fig. 2
Fig. 2
Outcome according to time post-injury (hours) and transfusion ratio (HMTP vs. LMTP) (a) multiorgan failure (MOF) (b) overall mortality
Fig. 3
Fig. 3
Number and time of hospital death in patients who received HMTP vs. LMTP in the first 4 h

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