Transfusion Ratio Of Plasma&RBC For Patients Who Need Massive Transfusion After Severe Trauma:A Systematic Analysis

Background and objective Patients with major bleeding following trauma always experienced a mass of blood loss and coagulation function disorder.Trauma induced coagulopathy is a clinical syndrome with coagulation disorders as the main manifestations,which always comes up with the patients who experienced severe trauma.Early recognition of massive hemorrhage with immediate initiation of hemostatic massive transfusion therapy treats the acute coagulopathy of trauma and improves survival.Massive transfusion,defined as the administration of 10 units of packed red blood cells(PRBCs)within 24 hours.Suitable transfusion ratio is crucial for patients with major bleeding following trauma.The European guideline on management of major bleeding and coagulopathy following trauma:fourth edition recommend that Plasma(FFP or pathogen-inactivated plasma)in a plasma-RBC ratio of at least 1:2 as needed.In an attempt to improve the comparison of high to low plasma:RBC ratio resuscitation,we undertook a systematic review of the published literatures where comparisons were made only between contemporaneous cohorts with similar injury profiles.After that,we also proceeded with another meta-analysis in order to ascertain the accurate transfusion ratio for patients following severe trauma.Methods Electronic databases consisting of Cochrane Library,Pubmed,Web of science,EMBASE were systemically searched from 2009.1 to 2016.12.The selection of studies,assessment of methodological quality and data extraction were performed independently by two researchers according to the including/excluding criteria.Statistical analyses were performed using RevMan software 5.3.Results(1)The first Part of the article:Five observation studies reporting outcomes for 1024 patients were included in this meta-analysis.Four studies were from civilian environments and one from a military setting.There were no significant differences in Injury Severity Score(ISS)between two ratio grops within studies.The patients in the high-ratio(plasma:RBC≥1:2)transfussion showed a significant reduction in 24-hours mortality compared to the low-ratio group(OR 0.35,95%CI[0.25,0.48],p<0.00001),and the 30-days mortality in the high-ratio group were still lower than the low-ratio group(ORO.55,95%CI[0.41,0.75],p=0.0001).Improved survival rate was observed in patients receiving a high plasma-RBC ratio over the first 24 hours(HR 2.34,95%CI[1.46,3.73],p=0.00001).(2)The second Part of the article:Four observation studies reporting outcomes for 430 patients were included in this systemic review.No significance in the blood routine examination and coagulation function shows between the group A(1:2-1:1)and the group B(>1:1).Conclusions(1)Raising the FFP:RBC ratio to 0.5 or higher may decrease the mortality of the patients who need massive transfusion after severe trauma.(2)For patients who have been serious traumatic,ensuring the FFP:RBC ratio to 0.5 or higher can improve survival.