THE IMPACT OF FRESH FROSEN PLASMA TO PACKED RED BLOOD CELL RATIO ON MORTALITY IN TRAUMATIC HEMORRHAGE: A NATIONWIDE ANALYSIS
Charlie Nederpelt, Majed El Hechi, Alexander Bonde, Napaporn Kongkaewpaisan, Nikolaos Kokoroskos, April Mendoza, Noelle Saillant, Martin Rosenthal, Peter Fagenholz, David King, David Chang, George Velmahos, Haytham Kaafarani.
Background:
The optimal ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) in trauma remains unclear. We sought to study the association between FFP:PRBC and early mortality in the hemorrhaging trauma patient.
Methods:
We included all trauma patients from TQIP participating hospitals (2013-2016) who were transfused ≥10 pRBCs and ≥1 FFP within 24 hours. We excluded transferred patients and those who died in the emergency department or had missing/inaccurate transfusion data. Patients were assigned to six FFP:PRBC cohorts (range 1:1 to 1:6) only if the ratio was similar at 4 and 24 hours and were excluded otherwise. Multivariable analyses correcting for all confounders [age, demographics, comorbidities, vital signs, injury severity scale (ISS) and mechanism, procedures performed] were derived to study the independent relationship between FFP:PRBC and 24-hour mortality.
Results:
Out of 1,002,595 patients, 4,427 patients were included. Mean age was 40 years, 79% were males, 61% had blunt trauma, and median ISS was 29. In multivariable analyses, the odds of mortality independently and incrementally increased to 1.32 [1.05-1.68] for a 1:2 ratio, 1.85 [1.11-3.08] for 1:4, and as high as 3.32 [1.20-9.22] for 1:6 (Figure 1, all p<0.05).
Conclusions:
A 1:1 FFP:PRBC ratio is associated with the lowest mortality in the hemorrhaging trauma patient and mortality gradually increases with decreasing ratios. 
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