High FFP to RBC Ratio Tied to Enhanced Blunt Trauma Survival

TOPLINE:

A fresh frozen plasma (FFP) to red blood cell (RBC) transfusion ratio above 1 is associated with decreased in-hospital mortality in patients with severe blunt trauma. A ceiling effect may be observed at ratios above 1.5.

METHODOLOGY:

• Researchers conducted a retrospective analysis of data from the Japan Trauma Data Bank, focusing on 1954 adult patients with severe blunt trauma, but without severe traumatic brain injury, who required blood transfusion.
• The median age of the patients was 61 years, and 63.6% were men.
• The patients were categorized into two groups for comparison: high FFP to RBC ratio (> 1) and low FFP to RBC ratio (< 1).
• The primary outcome was all-cause in-hospital mortality.
• The researchers also assessed transfusion-related adverse events such as pulmonary edema, acute kidney injury, sepsis, pulmonary thromboembolism, and acute respiratory distress syndrome.

TAKEAWAY:

• A total of 976 patients had a high FFP to RBC ratio, and the overall in-hospital mortality rate was 301.
• A high FFP to RBC ratio (> 1) was associated with a reduced in-hospital mortality rate in patients with severe blunt trauma (odds ratio, 0.73; 95% CI, 0.56-0.93).
• The researchers observed a nonlinear relationship between the FFP to RBC ratio and in-hospital mortality, indicating a potential ceiling effect at ratios above 1.5.
• The study found that the high-FFP group had higher frequencies of pulmonary edema (0.8%) and acute respiratory distress syndrome (1.4%) than the low-FFP group.

IN PRACTICE:

The authors wrote, “The transfusion of an FFP to RBC ratio greater than 1 was associated with a favorable outcome, which is partially different from the current transfusion consensus based on previous RCTs [randomized controlled trials].” They further added that “these outcomes highlight the importance of revising the current transfusion protocols to incorporate a high FFP to RBC ratio, warranting further research on optimal patient treatment.”

SOURCE:

The study was led by Gaku Fujiwara, MD, Department of Management of Technology and Intellectual Property, School of Public Health, Kyoto University, Kyoto, Japan. It was published online on August 21, 2024, in JAMA Surgery.

LIMITATIONS:

A limited number of patients with severe trauma required transfusion due to a decline in trauma cases. Attempts to control for survival bias by excluding patients who died within 30 minutes of presentation may have been insufficient due to the lack of time-dependent data. Concerns about external validity arose due to differences in trauma care practices, particularly in platelet transfusion, across countries. This was a retrospective observational study; hence, the certainty of the evidence was not as high as that of well-designed randomized controlled trials.

DISCLOSURES:

This study was supported by a scientific research grant from the Japan Society for the Promotion of Science. Yohei Okada received a research grant from the ZOLL Foundation and scholarships from the Japan Society for Promotion of Science, the Fukada Foundation for Medical Technology, and the International Medical Research Foundation. No additional disclosures were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.