Massachusetts Chapter of the American College of Surgeons

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Optimal Dose of Cryoprecipitate Infusion in Massive Transfusion Following Traumatic Injury
Ander Dorken Gallastegi, MD, Mary Bokenkamp, MD, John O. Hwabejire, MD, MPH, Jason Fawley, MD, April E. Mendoza, MD, MPH, Noelle Saillant, MD, Peter J. Fagenholz, MD, Haytham M.A. Kaafarani, MD, MPH, George C. Velmahos, MD, PhD, Jonathan J. Parks, MD
Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA

Background:
While evidence suggests that cryoprecipitate (Cryo) administration could be beneficial in trauma resuscitation, the optimal dose of Cryo remains unknown. We evaluated the optimal red blood cell (RBC):Cryo ratio during the early phase of resuscitation in massively transfused trauma patients.

Methods:
Adult patients in the ACS-TQIP database receiving massive transfusion (?4-units of RBC/4-hours), and ?1-unit of fresh frozen plasma and platelets within 4-hours were included. RBC:Cryo ratio was calculated based on the number of units transfused within 4-hours of presentation. The association between RBC:Cryo ratio and 24-hour mortality was analyzed with multivariable analysis adjusting for relevant variables.

Results:
The analysis included 14,762 patients. Median RBC:Cryo was 13 among those who received Cryo (n=4,617 [31.3%]). When compared to no Cryo administration, only RBC:Cryo ratios ?8:1 were associated with a statistically significant survival benefit, while lower doses of Cryo (RBC:Cryo>8:1) were not associated with a significant decrease in 24-hour mortality (Table 1a). Compared to maximum dose Cryo administration (RBC:Cryo=1:12:1), there was no statistically significant difference in 24-hour mortality up to RBC:Cryo=7:18:1, whereas lower doses of Cryo (RBC:Cryo>8:1) were associated with significantly increased adjusted risk for 24-hour mortality (Table 1b).

Conclusion:
A unit of Cryo per 7-8 units of RBC could be the optimal Cryo dose in trauma resuscitation that is associated with significantly higher survival while avoiding unnecessary use of blood products (Figure 2).


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