Improved survival after hemostatic resuscitation: does the emperor have no clothes?

This retrospective analysis of a cohort of 103 civilian trauma patients who required massive transfusion reports that the survival advantage of a high fresh frozen plasma (FFP) to packed red blood cell (PRBC) ratio (i.e. a FFP/PRBC ratio equal or superior to 1:2) may be related to a survival bias, namely the selection of patients not likely to die early.

The results of this study confirm those published recently by Snyder et al. (J Trauma 2009;66:358-62). The difference between these two studies is that FFP was administered earlier and almost concomitantly with PRBC in the Magnotti study, while it was administered with some delay in the Snyder study. Delayed administration of FFP in massive bleeding may also have a negative impact on patients’ survival.

– Philippe Van der Linden