Does a balanced transfusion ratio of plasma to packed red blood cells improve outcomes in both trauma and surgical patients? A meta-analysis of randomized controlled trials and observational studies. Review uri icon

Overview

abstract

  • BACKGROUND: The effect of high transfusion ratios of fresh frozen plasma (FFP): packed red blood cell (RBC) on mortality is still controversial. Observational evidence contradicts a recent randomized controlled trial regarding mortality benefit. This is an updated meta-analysis, including a non-trauma cohort. METHODS: Patients were grouped into high vs. low based on FFP:RBC ratio. Primary outcomes were 24-h and 30-day/in-hospital mortality. Secondary outcomes were acute respiratory distress syndrome and acute lung injury rates. Random model and leave-one-out-analyses were used. RESULTS: In 36 studies, lower ratio showed poorer 24-h and 30-day survival (p < 0.001). In trauma and non-trauma settings, a lower ratio was associated with worse 24-h and 30-day mortality (P < 0.001). A ratio of 1:1.5 provided the largest 24-h and 30-day survival benefit (p < 0.001). The ratio was not associated with ARDS or ALI. CONCLUSIONS: High FFP:RBC ratio confers survival benefits in trauma and non-trauma settings, with the highest survival benefit at 1:1.5.

publication date

  • September 23, 2017

Research

keywords

  • Blood Transfusion
  • Observational Studies as Topic
  • Plasma
  • Postoperative Complications
  • Randomized Controlled Trials as Topic
  • Shock, Traumatic

Identity

Scopus Document Identifier

  • 85030475914

Digital Object Identifier (DOI)

  • 10.1016/j.amjsurg.2017.08.045

PubMed ID

  • 28969893

Additional Document Info

volume

  • 216

issue

  • 2