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.

Autor: Rahouma M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. Electronic address: mhmdrahouma@gmail.com., Kamel M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Jodeh D; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Kelley T; Department of Surgery, Dwight D Eisenhower Army Medical Center, Augusta, GA, USA., Ohmes LB; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., de Biasi AR; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Abouarab AA; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Benedetto U; Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom., Guy TS; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Lau C; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Lee PC; Cardiothoracic Surgery, Northwell Health, Hofstra Northwell School of Medicine, New York, NY, USA., Girardi LN; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA., Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2018 Aug; Vol. 216 (2), pp. 342-350. Date of Electronic Publication: 2017 Sep 23.
DOI: 10.1016/j.amjsurg.2017.08.045
Abstrakt: 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.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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