Table 4 Review of massive transfusion studies
Reference | N of pts | Mechanism | Massive transfusion definition | Time ratio calculated | Plasma : PRBC ratio | Results |
|---|---|---|---|---|---|---|
Borgman et al., 2007 [4] | 246 | 94 % penetrating (military) | ≥9 U RBC in 1st 24 h | 24 h | Low: 1:8, | Overall Mortality in low −65%, medium-34%, high-19 %, (P < .001). |
Medium: 1:2.5 | ||||||
High:1:1.4 | ||||||
Sperry et al., 2008 [5] | 415 | 100 % blunt | ≥8 U RBC in 1st 8 h | 12 h | Low: < 1 : 1.5 | 24-h mortality in low-12.8%, high - 3.9% (P = 0.012). Benefit gone by 48 h |
High: ≥ 1 : 1.5 | ||||||
Holcomb et al., 2008 [14] | 466 | 35 % penetrating | ≥9 U RBC in 1st 24 h | 24 h | Low: < 1 : 2 | Improved 30-day survival in high ratio (59.6 vs. 40.4 %; P < 0.01) |
High: ≥ 1 : 2 | ||||||
Gunter et al. 2008 (15) | 259 | 55 % penetrating | ≥10 U RBC in 1st 24 h | 24 h | Low: < 1 : 1.5 | reduction in 30-day mortality: high (41 %) vs. low (62 %) ratio group p = 0.008 |
High: ≥ 1 : 1.5 | ||||||
Maegele et al., 2008 [16] | 713 | 92 % blunt | ≥10 U RBC ED → ICU admission | NA | PRBC:FFP > 1.1, PRBC:FFP 0.9-1.1 | 6 h mortality 24.6, 9.6 & 3.5 % (P < 0.0001) |
PRBC:FFP < 0.9 | 24 h mortality 32.6, 16.7 & 11.3 % (P < 0.0001) | |||||
30 day mortality 45.5, 35.1 & 24 % (P < 0.001) | ||||||
Snyder et al., 2009 [17] | 134 | 60 % penetrating | ≥10 U RBC in 1st 24 h | 24 h | Low: < 1 : 2 | 24-h mortality in low-58%, High - 40 %; but effect disappears when analyzed as time-dependent variable |
High: ≥ 1 : 2 | ||||||
Teixeira et al., 2009 [18] | 383 | NA | ≥10 U RBC in 1st 24 h | 24 h | Low: ≤ 1:8, | Mortality rate decreased significantly with increased FFP; but effect disappears after a 1:3 ratio. |
Medium: >1:8 & ≤1:3 | ||||||
High: >1:3 & ≤ 1:2 | ||||||
Mitra et al., 2010 [19] | 331 | 86 % blunt | ≥5 U RBC in 1st 4 h | 4 h | >1:1.5 | higher ratios were associated with significantly improved mortality rates |
>1:2.5 to 1:1.5 | ||||||
>1:3.5 to 1:2.5 | ||||||
≤1:3.5 | ||||||
Magnotti et al., 2011 [20] | 103 | 63 % blunt | ≥10 U RBC in 1st 24 h | 6 h | Low: < 1 : 2 | 6-h mortality was less in the high-group (10% vs. 48 %, p < 0.002) |
High: ≥ 1 : 2 | ||||||
Lustenberger et al. 2011 [21] | 229 | 100 % blunt | ≥10 U RBC in 1st 24 h | 12, 24 h | Low: < 1 : 1.5 | High ratio was associated with improved survival at 12 and 24 h |
High: ≥ 1 : 1.5 | ||||||
Brown et al., 2012 [22] | 604 | 100 % blunt | ≥10 U RBC in 1st 24 h | 6, 12, 24 h | Low: < 1 : 1.5 | High 6-h ratios were associated with a reduction in mortality risk at 6, 12, and 24 h (p < 0.05). |
High: ≥ 1 : 1.5 | ||||||
Kudo et al., 2013 [23] | NA | NA | ≥10 U RBC in 1st 24 h | 6 h | High: >1:1.5, | Mortality rate: high (44.4 %); |
Medium: 1:1.5-1:2 | Middle (16.7 %); low (33.3 %) | |||||
Low: <1:2 | ||||||
Holcomb et al., 2015 [24] | 680 | Severely injured (55 % blunt) | ≥10 U of RBCs within 24 h | 6 h | 1:1:1 transfusion ratio of plasma, platelets, and RBCs to a 1:1:2 ratio | early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 h or at 30 days |
Present study | 77 | 88.3 % Blunt | ≥10 U RBC in 1st 24 h | 4 h | Low: < 1 : 1.5 | higher ratios were significantly associated with lower rate of mortality and MOF within initial 4 h of injury |
11.7 % penetrating | High: ≥ 1 : 1.5 |