Impact of inverse ratios on patients with exsanguinating vascular injuries
| Autor: | Chrissy Guidry, Eric R. Simms, Jeff DellaVope, Jodran Guice, Peter Meade, Jiselle Bock Heaney, Norman E. McSwain, Juan Duchesne |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Erythrocyte transfusion Resuscitation Time Factors Blood transfusion medicine.medical_treatment Kaplan-Meier Estimate Critical Care and Intensive Care Medicine Plasma Exsanguination medicine Humans Blood Transfusion In patient Survival analysis Retrospective Studies Chi-Square Distribution business.industry Retrospective cohort study Vascular System Injuries Survival Analysis Anesthesia Female Surgery Erythrocyte Transfusion business Chi-squared distribution |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 74:403-410 |
| ISSN: | 2163-0755 |
| Popis: | Resuscitation strategies in patients with severe hemorrhage have evolved throughout the years. Optimal resuscitation ratios for civilian exsanguinating vascular injuries has not been determined. We hypothesize improved outcomes in patients with exsanguinating vascular injuries when an aggressive hemostatic resuscitation is used with an inverse ratio of fresh frozen plasma (FFP) to packed red blood cell (PRBC).This is a 5-year retrospective analysis of vascular injuries requiring hemostatic resuscitation. Resuscitation groups by ratios of FFP/PRBC were inverse (1:1), high (1-1:2), and low (1:2). Patients with 10 or greater units of PRBC (massively transfused patients) were evaluated in each of the resuscitation groups. Demographics and complications throughout hospital length of stay and were compared between the resuscitation groups. Survivability Kaplan-Meier curves were generated at 6 hours and 5 days.A total of 258 patients with vascular injuries required component therapy resuscitation (low, n = 78; high, n = 156; inverse, n = 24). Massively transfused patients (n = 162, 62.7%) showed a significant Kaplan-Meier survivability difference at 6 hours (low, 65.0% vs. high, 75.0% vs. inverse, 100%, p = 0.024) and at 5 days (low, 52.5% vs. high, 62.0% vs. inverse, 100%, p = 0.008). Moreover, for massively transfused patients with extremity vascular injuries (n = 65, 39%), a relationship between resuscitation ratio and amputations was significant (low vs. high vs. inverse was 36.8% vs. 12.8% vs. 0%, respectively; p = 0.033).This is the first study that highlights the potential outcomes benefits of an inverse ratio of FFP-PRBC in patients with exsanguinating vascular injuries. Multi-institutional prospective analysis is needed to potentially elucidate the cytoprotective effect of FFP to validate these results.Therapeutic study, level IV; diagnostic study, level III. |
| Databáze: | OpenAIRE |
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