85 Safety and Efficacy of Early Fresh Frozen Plasma Administration in Burn Resuscitation

Abstract

Abstract Introduction Controversy exists over the use of colloid required for burn resuscitation. Data show that fresh frozen plasma (FFP) may have benefits beyond volume sparing alone, however, there are inherent risks including transfusion related acute lung injury (TRALI) and transfusion reactions (TR). The aims of this project were: (1) determine the effectiveness of early FFP during burn resuscitation, and (2) to document any potential side effects of FFP administration. Methods A retrospective review was performed on all burn patients aged >18 years old with >20% total body surface area (TBSA) burns who underwent resuscitation using our nursing guided resuscitation protocol (NGRP) from November 2016- June 2019 at our ABA- verified burn center. Excluded were those with electrical injury, delayed resuscitation, polytrauma, renal replacement therapy and or death within 24 hours (hrs) of injury. Pursuant to the NGRP all patients with >30% TBSA burns received FFP at 6–8 hrs post injury. Data recorded included: demographics, % TBSA burned, total crystalloid/FFP, and urine output (UO). An hourly resuscitation ratio (I/O ratio) of fluid given (ml/kg/%TBSA/hr) to UO (ml/kg/hr) was calculated. FFP initiation was standardized to time zero. Major complications such as abdominal compartment syndrome (ACS), acute respiratory distress syndrome (ARDS), TRALI and TR were documented. Univariate statistical analysis was performed. Results Over the study period 71 patients required NGRP resuscitation, 56 met inclusion criteria. Baseline demographics included: 47 male (84%), median age 34 years [IQR 27–53], median TBSA 30% [range 20–95%]. 40 patients were resuscitated with FFP versus 16 patients resuscitated with crystalloid alone. Median time to FFP administration was 7 hours [IQR 6–8] with an average of 1866 ml infused [779–4484]. Those who received FFP had larger % TBSA burns median 41% [29–57] vs no FFP 22% [20–24], p< 0.001. Median I/O ratio at FFP initiation improved from 1.0 [IQR 0.4–3.7] to 0.4 [IQR 0.2–1.5, p=0.01] at 2 hrs post FFP, see Graph. Median UOP improved from 0.18 cc/kg/hr the 2 hrs prior to FFP administration, to 0.44 cc/kg/hr at 2 hrs post FFP (p=0.01). Total 24 hour fluids given (cc/kg/% TBSA) were similar in both groups: FFP 3.94 [3.49–5.36] vs no FFP 3.92 [3.54–4.53], p=0.77. There were no reported incidents of ACS, ARDS, TRALI, or TR. Conclusions The use of FFP in burn resuscitation significantly improves UOP and normalizes I/O ratios. FFP administration did not cause any serious complications. Applicability of Research to Practice Future research efforts should focus on comparing albumin vs FFP in acute burn resuscitation.