Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm

Matthew Mell, Amy S. O'Neil, Rachael A. Callcut, Charles W. Acher, John R. Hoch, Girma Tefera, William D. Turnipseed

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). Methods: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis. Results: One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004). Conclusion: For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.

Original languageEnglish (US)
Pages (from-to)955-962
Number of pages8
JournalSurgery
Volume148
Issue number5
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

Fingerprint

Aortic Rupture
Abdominal Aortic Aneurysm
Mortality
Hemorrhage
Multivariate Analysis
Ischemia
Erythrocyte Transfusion
Vital Signs
Patient Admission
Incidence
Resuscitation
Colon
Odds Ratio
Demography
Prospective Studies
Confidence Intervals
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Mell, M., O'Neil, A. S., Callcut, R. A., Acher, C. W., Hoch, J. R., Tefera, G., & Turnipseed, W. D. (2010). Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Surgery, 148(5), 955-962. https://doi.org/10.1016/j.surg.2010.02.002

Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. / Mell, Matthew; O'Neil, Amy S.; Callcut, Rachael A.; Acher, Charles W.; Hoch, John R.; Tefera, Girma; Turnipseed, William D.

In: Surgery, Vol. 148, No. 5, 01.11.2010, p. 955-962.

Research output: Contribution to journalArticle

Mell, M, O'Neil, AS, Callcut, RA, Acher, CW, Hoch, JR, Tefera, G & Turnipseed, WD 2010, 'Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm', Surgery, vol. 148, no. 5, pp. 955-962. https://doi.org/10.1016/j.surg.2010.02.002
Mell, Matthew ; O'Neil, Amy S. ; Callcut, Rachael A. ; Acher, Charles W. ; Hoch, John R. ; Tefera, Girma ; Turnipseed, William D. / Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. In: Surgery. 2010 ; Vol. 148, No. 5. pp. 955-962.
@article{747b68c980c444adaabab75ba391a26c,
title = "Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm",
abstract = "Background: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). Methods: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis. Results: One hundred and twenty-eight of the 168 (76{\%}) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85{\%}) were men. Thirty-day mortality was 22.6{\%} (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15{\%} vs 39{\%}; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95{\%} confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4{\%} vs 41.1{\%}; P = .004). Conclusion: For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.",
author = "Matthew Mell and O'Neil, {Amy S.} and Callcut, {Rachael A.} and Acher, {Charles W.} and Hoch, {John R.} and Girma Tefera and Turnipseed, {William D.}",
year = "2010",
month = "11",
day = "1",
doi = "10.1016/j.surg.2010.02.002",
language = "English (US)",
volume = "148",
pages = "955--962",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm

AU - Mell, Matthew

AU - O'Neil, Amy S.

AU - Callcut, Rachael A.

AU - Acher, Charles W.

AU - Hoch, John R.

AU - Tefera, Girma

AU - Turnipseed, William D.

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). Methods: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis. Results: One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004). Conclusion: For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.

AB - Background: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). Methods: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis. Results: One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004). Conclusion: For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.

UR - http://www.scopus.com/inward/record.url?scp=77958106886&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77958106886&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2010.02.002

DO - 10.1016/j.surg.2010.02.002

M3 - Article

C2 - 20378142

AN - SCOPUS:77958106886

VL - 148

SP - 955

EP - 962

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 5

ER -