Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion

Kenji Inaba, Bernardino C. Branco, Peter M Rhee, Lorne H. Blackbourne, John B. Holcomb, Pedro G R Teixeira, Ira Shulman, Janice Nelson, Demetrios Demetriades

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Background: For trauma patients requiring massive blood transfusion, aggressive plasma usage has been demonstrated to confer a survival advantage. The aim of this study was to evaluate the impact of plasma administration in nonmassively transfused patients. Study Design: Trauma patients admitted to a Level I trauma center (2000-2005) requiring a nonmassive transfusion (<10 U packed RBC [PRBC] within 12 hours of admission) were identified retrospectively. Propensity scores were calculated to match and compare patients receiving plasma in the first 12 hours with those who did not. Results: The 1,716 patients (86.1% of 1,933 who received PRBC transfusion) received a nonmassive transfusion. After exclusion of 31 (1.8%) early deaths, 284 patients receiving plasma were matched to patients who did not. There was no improvement in survival with plasma transfusion (17.3% versus 14.1%; p = 0.30) irrespective of the plasma-to-PRBC ratio achieved. However, the overall complication rate was significantly higher for patients receiving plasma (26.8% versus 18.3%, odds ratio [OR] = 1.7; 95% CI, 1.1-2.4; p = 0.016). As the volume of plasma increased, an increase in complications was seen, reaching 37.5% for patients receiving >6 U. The ARDS rate specifically was also significantly higher in patients receiving plasma (9.9% versus 3.5%, OR = 3.0; 95% CI, 1.4-6.2; p = 0.004]. Patients receiving >6 U plasma had a 12-fold increase in ARDS, a 6-fold increase in multiple organ dysfunction syndrome, and a 4-fold increase in pneumonia and sepsis. Conclusions: For nonmassively transfused trauma patients, plasma administration was associated with a substantial increase in complications, in particular ARDS, with no improvement in survival. An increase in multiple organ dysfunction, pneumonia, and sepsis was likewise seen as increasing volumes of plasma were transfused. The optimal trigger for initiation of a protocol for aggressive plasma infusion warrants prospective evaluation.

Original languageEnglish (US)
Pages (from-to)957-965
Number of pages9
JournalJournal of the American College of Surgeons
Volume210
Issue number6
DOIs
StatePublished - Jun 2010

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Wounds and Injuries
Sepsis
Pneumonia
Survival
Multiple Organ Failure
Plasma Volume
Trauma Centers
Blood Transfusion

ASJC Scopus subject areas

  • Surgery

Cite this

Inaba, K., Branco, B. C., Rhee, P. M., Blackbourne, L. H., Holcomb, J. B., Teixeira, P. G. R., ... Demetriades, D. (2010). Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion. Journal of the American College of Surgeons, 210(6), 957-965. https://doi.org/10.1016/j.jamcollsurg.2010.01.031

Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion. / Inaba, Kenji; Branco, Bernardino C.; Rhee, Peter M; Blackbourne, Lorne H.; Holcomb, John B.; Teixeira, Pedro G R; Shulman, Ira; Nelson, Janice; Demetriades, Demetrios.

In: Journal of the American College of Surgeons, Vol. 210, No. 6, 06.2010, p. 957-965.

Research output: Contribution to journalArticle

Inaba, K, Branco, BC, Rhee, PM, Blackbourne, LH, Holcomb, JB, Teixeira, PGR, Shulman, I, Nelson, J & Demetriades, D 2010, 'Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion', Journal of the American College of Surgeons, vol. 210, no. 6, pp. 957-965. https://doi.org/10.1016/j.jamcollsurg.2010.01.031
Inaba, Kenji ; Branco, Bernardino C. ; Rhee, Peter M ; Blackbourne, Lorne H. ; Holcomb, John B. ; Teixeira, Pedro G R ; Shulman, Ira ; Nelson, Janice ; Demetriades, Demetrios. / Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 6. pp. 957-965.
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abstract = "Background: For trauma patients requiring massive blood transfusion, aggressive plasma usage has been demonstrated to confer a survival advantage. The aim of this study was to evaluate the impact of plasma administration in nonmassively transfused patients. Study Design: Trauma patients admitted to a Level I trauma center (2000-2005) requiring a nonmassive transfusion (<10 U packed RBC [PRBC] within 12 hours of admission) were identified retrospectively. Propensity scores were calculated to match and compare patients receiving plasma in the first 12 hours with those who did not. Results: The 1,716 patients (86.1{\%} of 1,933 who received PRBC transfusion) received a nonmassive transfusion. After exclusion of 31 (1.8{\%}) early deaths, 284 patients receiving plasma were matched to patients who did not. There was no improvement in survival with plasma transfusion (17.3{\%} versus 14.1{\%}; p = 0.30) irrespective of the plasma-to-PRBC ratio achieved. However, the overall complication rate was significantly higher for patients receiving plasma (26.8{\%} versus 18.3{\%}, odds ratio [OR] = 1.7; 95{\%} CI, 1.1-2.4; p = 0.016). As the volume of plasma increased, an increase in complications was seen, reaching 37.5{\%} for patients receiving >6 U. The ARDS rate specifically was also significantly higher in patients receiving plasma (9.9{\%} versus 3.5{\%}, OR = 3.0; 95{\%} CI, 1.4-6.2; p = 0.004]. Patients receiving >6 U plasma had a 12-fold increase in ARDS, a 6-fold increase in multiple organ dysfunction syndrome, and a 4-fold increase in pneumonia and sepsis. Conclusions: For nonmassively transfused trauma patients, plasma administration was associated with a substantial increase in complications, in particular ARDS, with no improvement in survival. An increase in multiple organ dysfunction, pneumonia, and sepsis was likewise seen as increasing volumes of plasma were transfused. The optimal trigger for initiation of a protocol for aggressive plasma infusion warrants prospective evaluation.",
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AU - Branco, Bernardino C.

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AU - Blackbourne, Lorne H.

AU - Holcomb, John B.

AU - Teixeira, Pedro G R

AU - Shulman, Ira

AU - Nelson, Janice

AU - Demetriades, Demetrios

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