Early high ratio platelet transfusion in trauma resuscitation and its outcomes
Ruben Peralta1, Adarsh Vijay2, Ayman El-Menyar3, Rafael Consunji2, Ibrahim Afifi2, Ismail Mahmood2, Mohammed Asim4, Rifat Latifi5, Hassan Al-Thani2
1 Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar; University National Pedro Henriquez Urena, Department of Surgery, Santo Domingo, Dominican Republic
2 Department of Surgery, Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
3 Clinical Research, Trauma Surgery Section, Hamad General Hospital; Internal Medicine, Weill Cornell Medical College, Doha, Qatar
4 Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
5 Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Department of Surgery, University of Arizona, Tucson, AZ, USA
Department of Surgery, Hamad General Hospital, HMC, P. O. Box 3050, Doha
Source of Support: None, Conflict of Interest: None
Introduction: The optimal ratio of platelets (PLTs) to packed red blood cell (PRBC) in trauma patients requiring massive transfusion protocol (MTP) is still controversial. This report aims to describe the effect of attaining a high PLT:PRBC ratio (≥1:1.5) within 4 h postinjury on the outcomes of trauma patients receiving MTP.
Methods: Over a 24-month period, records of all adult patients with traumatic injury who received MTP were retrospectively reviewed. Data were analyzed with respect to PLT:PRBC ratio ([high-MTP ≥1:1.5] [HMTP] vs. [low-MTP <1:1.5] [LMTP]) given within the first 4 h postinjury and also between (>4 and 24 h). Baseline demographic, clinical characteristics, complications, and outcomes were compared according to HMTP and LMTP.
Results: Of the total 3244 trauma patients, PLT:PRBC ratio was attainable in 58 (1.2%) patients who fulfilled the inclusion criteria. The mean age was 32.3 ± 10.7 years; the majority were males (89.6%) with high mean Injury Severity Score (ISS): 31.9 ± 11.5 and Revise Trauma Score (RTS): 5.1 ± 2.2. There was no significant association between age, gender, type of injury, presenting hemoglobin, International Normalized Ratio, ISS, and RTS. The rate of ventilator-associated pneumonia (38.9% vs. 10.8%; P = 0.02) and wound infection (50% vs. 10.8%; P = 0.002) were significantly higher in the HMTP group. However, HMTP was associated with lower rate of multiple organ failure (MOF) (42.1% vs. 87.2%, P = 0.001) and mortality (36.8% vs. 84.6%, P = 0.001) within the first 30 days postinjury.
Conclusions: Our study revealed that early attainment of high PLT/PRBC ratio within 4 h postinjury is significantly associated with lower MOF and mortality in trauma patients.