Prospective comparison of packed red blood cell-to-fresh frozen plasma transfusion ratio of 4: 1 versus 1: 1 during acute massive burn excision

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND: Acute burn excision results in at least 2% blood volume loss per percent excised; hence, massive blood loss (>50% total blood volume) occurs during major burn excisions. The purpose of this pilot study was to assess safety and prospectively compare the impact of a 4:1 versus a 1:1 packed red blood cell-fresh frozen plasma (PRBC/FFP) transfusion strategy on outcomes in children with burns greater than 20% total body surface area (TBSA). METHODS: Children with greater than 20% TBSA burn were randomized to a 1:1 or 4:1 PRBC/FFP ratio during burn excision. Parameters measured on admission included demographics, burn size, and Pediatric Risk of Mortality scores. Laboratory values that were measured preoperatively, 1 hour, 12 hours, 24 hours, and 1 week included prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), fibrinogen, protein C, and antithrombin C (AIII). Total number of blood products transfused during operative interventions and during hospitalization were recorded. RESULTS: Groups were similar in age, weight, TBSA, and Pediatric Risk of Mortality scores at admission. Preoperative fibrinogen, antithrombins III (AIII), protein C, hemoglobin, PT/PTT, INR, and platelets were similar between groups. The 1:1 group received more FFP (43.8 ± 0.03 U in 1:1 group vs. 15.7 ± 0.07 in the 4:1 group) and less PRBC (40.7 ± 0.02 U in 1:1 group vs. 73.1 ± 0.02 U in 4:1 group) than the 4:1 group. Approximately 50% blood volume was replaced with PRBC intraopaeratively. There was no difference in PT/PTT, INR, hemoglobin, or platelets between groups. Protein C and AIII were higher in the 1:1 group. Cost of FFP and PRBC were lower in the 1:1 group. CONCLUSION: A 1:1 PRBC/FFP transfusion strategy increased FFP use, decreased overall PRBC use, and resulted in higher AIII and protein C postoperatively without a difference in INR or PT/PTT. This may represent compensatory changes in the 4:1 group in response to intraoperative blood loss. LEVEL OF EVIDENCE: Therapeutic, level II.

Original languageEnglish (US)
Pages (from-to)76-83
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

International Normalized Ratio
Antithrombin III
Partial Thromboplastin Time
Prothrombin Time
Protein C
Body Surface Area
Erythrocytes
Blood Volume
Antithrombin Proteins
Fibrinogen
Hemoglobins
Blood Platelets
Pediatrics
Antithrombins
Mortality
Burns
Hospitalization
Demography
Safety
Weights and Measures

Keywords

  • Coagulation
  • massive transfusion
  • outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

@article{9abd7aab45194cc2999626ab7003cf4f,
title = "Prospective comparison of packed red blood cell-to-fresh frozen plasma transfusion ratio of 4: 1 versus 1: 1 during acute massive burn excision",
abstract = "BACKGROUND: Acute burn excision results in at least 2{\%} blood volume loss per percent excised; hence, massive blood loss (>50{\%} total blood volume) occurs during major burn excisions. The purpose of this pilot study was to assess safety and prospectively compare the impact of a 4:1 versus a 1:1 packed red blood cell-fresh frozen plasma (PRBC/FFP) transfusion strategy on outcomes in children with burns greater than 20{\%} total body surface area (TBSA). METHODS: Children with greater than 20{\%} TBSA burn were randomized to a 1:1 or 4:1 PRBC/FFP ratio during burn excision. Parameters measured on admission included demographics, burn size, and Pediatric Risk of Mortality scores. Laboratory values that were measured preoperatively, 1 hour, 12 hours, 24 hours, and 1 week included prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), fibrinogen, protein C, and antithrombin C (AIII). Total number of blood products transfused during operative interventions and during hospitalization were recorded. RESULTS: Groups were similar in age, weight, TBSA, and Pediatric Risk of Mortality scores at admission. Preoperative fibrinogen, antithrombins III (AIII), protein C, hemoglobin, PT/PTT, INR, and platelets were similar between groups. The 1:1 group received more FFP (43.8 ± 0.03 U in 1:1 group vs. 15.7 ± 0.07 in the 4:1 group) and less PRBC (40.7 ± 0.02 U in 1:1 group vs. 73.1 ± 0.02 U in 4:1 group) than the 4:1 group. Approximately 50{\%} blood volume was replaced with PRBC intraopaeratively. There was no difference in PT/PTT, INR, hemoglobin, or platelets between groups. Protein C and AIII were higher in the 1:1 group. Cost of FFP and PRBC were lower in the 1:1 group. CONCLUSION: A 1:1 PRBC/FFP transfusion strategy increased FFP use, decreased overall PRBC use, and resulted in higher AIII and protein C postoperatively without a difference in INR or PT/PTT. This may represent compensatory changes in the 4:1 group in response to intraoperative blood loss. LEVEL OF EVIDENCE: Therapeutic, level II.",
keywords = "Coagulation, massive transfusion, outcomes",
author = "Palmieri, {Tina L} and Greenhalgh, {David G} and Soman Sen",
year = "2013",
month = "1",
doi = "10.1097/TA.0b013e31827891b7",
language = "English (US)",
volume = "74",
pages = "76--83",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Prospective comparison of packed red blood cell-to-fresh frozen plasma transfusion ratio of 4

T2 - 1 versus 1: 1 during acute massive burn excision

AU - Palmieri, Tina L

AU - Greenhalgh, David G

AU - Sen, Soman

PY - 2013/1

Y1 - 2013/1

N2 - BACKGROUND: Acute burn excision results in at least 2% blood volume loss per percent excised; hence, massive blood loss (>50% total blood volume) occurs during major burn excisions. The purpose of this pilot study was to assess safety and prospectively compare the impact of a 4:1 versus a 1:1 packed red blood cell-fresh frozen plasma (PRBC/FFP) transfusion strategy on outcomes in children with burns greater than 20% total body surface area (TBSA). METHODS: Children with greater than 20% TBSA burn were randomized to a 1:1 or 4:1 PRBC/FFP ratio during burn excision. Parameters measured on admission included demographics, burn size, and Pediatric Risk of Mortality scores. Laboratory values that were measured preoperatively, 1 hour, 12 hours, 24 hours, and 1 week included prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), fibrinogen, protein C, and antithrombin C (AIII). Total number of blood products transfused during operative interventions and during hospitalization were recorded. RESULTS: Groups were similar in age, weight, TBSA, and Pediatric Risk of Mortality scores at admission. Preoperative fibrinogen, antithrombins III (AIII), protein C, hemoglobin, PT/PTT, INR, and platelets were similar between groups. The 1:1 group received more FFP (43.8 ± 0.03 U in 1:1 group vs. 15.7 ± 0.07 in the 4:1 group) and less PRBC (40.7 ± 0.02 U in 1:1 group vs. 73.1 ± 0.02 U in 4:1 group) than the 4:1 group. Approximately 50% blood volume was replaced with PRBC intraopaeratively. There was no difference in PT/PTT, INR, hemoglobin, or platelets between groups. Protein C and AIII were higher in the 1:1 group. Cost of FFP and PRBC were lower in the 1:1 group. CONCLUSION: A 1:1 PRBC/FFP transfusion strategy increased FFP use, decreased overall PRBC use, and resulted in higher AIII and protein C postoperatively without a difference in INR or PT/PTT. This may represent compensatory changes in the 4:1 group in response to intraoperative blood loss. LEVEL OF EVIDENCE: Therapeutic, level II.

AB - BACKGROUND: Acute burn excision results in at least 2% blood volume loss per percent excised; hence, massive blood loss (>50% total blood volume) occurs during major burn excisions. The purpose of this pilot study was to assess safety and prospectively compare the impact of a 4:1 versus a 1:1 packed red blood cell-fresh frozen plasma (PRBC/FFP) transfusion strategy on outcomes in children with burns greater than 20% total body surface area (TBSA). METHODS: Children with greater than 20% TBSA burn were randomized to a 1:1 or 4:1 PRBC/FFP ratio during burn excision. Parameters measured on admission included demographics, burn size, and Pediatric Risk of Mortality scores. Laboratory values that were measured preoperatively, 1 hour, 12 hours, 24 hours, and 1 week included prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), fibrinogen, protein C, and antithrombin C (AIII). Total number of blood products transfused during operative interventions and during hospitalization were recorded. RESULTS: Groups were similar in age, weight, TBSA, and Pediatric Risk of Mortality scores at admission. Preoperative fibrinogen, antithrombins III (AIII), protein C, hemoglobin, PT/PTT, INR, and platelets were similar between groups. The 1:1 group received more FFP (43.8 ± 0.03 U in 1:1 group vs. 15.7 ± 0.07 in the 4:1 group) and less PRBC (40.7 ± 0.02 U in 1:1 group vs. 73.1 ± 0.02 U in 4:1 group) than the 4:1 group. Approximately 50% blood volume was replaced with PRBC intraopaeratively. There was no difference in PT/PTT, INR, hemoglobin, or platelets between groups. Protein C and AIII were higher in the 1:1 group. Cost of FFP and PRBC were lower in the 1:1 group. CONCLUSION: A 1:1 PRBC/FFP transfusion strategy increased FFP use, decreased overall PRBC use, and resulted in higher AIII and protein C postoperatively without a difference in INR or PT/PTT. This may represent compensatory changes in the 4:1 group in response to intraoperative blood loss. LEVEL OF EVIDENCE: Therapeutic, level II.

KW - Coagulation

KW - massive transfusion

KW - outcomes

UR - http://www.scopus.com/inward/record.url?scp=84872075781&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872075781&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31827891b7

DO - 10.1097/TA.0b013e31827891b7

M3 - Article

C2 - 23271080

AN - SCOPUS:84872075781

VL - 74

SP - 76

EP - 83

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -