High plasma to red blood cell ratios are associated with lower mortality rates in patients receiving multiple transfusion (4 <= red blood cell units < 10) during acute trauma resuscitation.

The article by Wafaisade et al. is a retrospective observational multicenter study assessing the impact of different FFP:RBC ratios (low ratio [LR], < 1:1; medium ratio (MR), 1:1; high ratio (HR), > 1:1) on morbidity and mortality in 1362 trauma patients with an ISS of 16 or above receiving between 4 and 9 units of RBC in the resuscitation phase.

No significant difference in the incidence of sepsis (LR = 17.1%, MR = 18.2%, HR = 17.6%) or multiple organ failure (LR = 49.1%, MR = 47.9%, HR = 52.4%) between groups was found, whereas mortality was significantly reduced in the HR group (LR = 26.8%, MR = 21.7%, HR = 15.2%, P = 0.001). The HR group also had a lower incidence of ongoing RBC transfusion in the ICU and a high FFP:RBC was an independent predictor for survival by multivariate logistic regression analysis (OR 0.52, P = 0.013), suggesting the importance of FFP administration for outcome also in non-massively transfused trauma patients.

– Pär Johansson