Does a balanced transfusion ratio of plasma to packed red blood cells improve outcomes in both trauma and surgical patients? A meta-analysis of randomized controlled trials and observational studies

Mohamed Rahouma*, Mohamed Kamel, Diana Jodeh, Thomas Kelley, Lucas B. Ohmes, Andreas R. de Biasi, Ahmed A. Abouarab, Umberto Benedetto, T. Sloane Guy, Christopher Lau, Paul C. Lee, Leonard N. Girardi, Mario Gaudino

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)

6 Citations (Scopus)
286 Downloads (Pure)

Abstract

Background: The effect of high transfusion ratios of fresh frozen plasma (FFP): packed red blood cell (RBC) on mortality is still controversial. Observational evidence contradicts a recent randomized controlled trial regarding mortality benefit. This is an updated meta-analysis, including a non-trauma cohort. 


Methods: Patients were grouped into high vs. low based on FFP:RBC ratio. Primary outcomes were 24-h and 30-day/in-hospital mortality. Secondary outcomes were acute respiratory distress syndrome and acute lung injury rates. Random model and leave-one-out-analyses were used. 


Results: In 36 studies, lower ratio showed poorer 24-h and 30-day survival (p < 0.001). In trauma and non-trauma settings, a lower ratio was associated with worse 24-h and 30-day mortality (P < 0.001). A ratio of 1:1.5 provided the largest 24-h and 30-day survival benefit (p < 0.001). The ratio was not associated with ARDS or ALI. 


Conclusions: High FFP:RBC ratio confers survival benefits in trauma and non-trauma settings, with the highest survival benefit at 1:1.5.

Original languageEnglish
Pages (from-to)342-350
Number of pages9
JournalAmerican Journal of Surgery
Volume216
Issue number2
Early online date23 Sep 2017
DOIs
Publication statusPublished - 1 Aug 2018

Keywords

  • 24-h and 30-day/in-hospital mortality
  • Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) rates
  • Fresh frozen plasma (FFP): packed red blood cell (RBC) ratio
  • Meta-analysis

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