Effect of Early Plasma Transfusion on Mortality in Patients with Ruptured Abdominal Aortic Aneurysm

Abstract

Research in the area of trauma resuscitation has shown a decrease in mortality with a lower packed-red-blood-cell (RPBC) to fresh-frozen-plasma (FFP) transfusion ratio. The authors of the current study sought to determine the effect of the PRBC:FFP ratio on mortality of patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA). The authors conducted a retrospective review of RAAA patients at the University of Wisconsin who suffered massive hemorrhage, requiring 10 or more units of blood products before the conclusion of their operative repair. They examined a host of clinical variables, including patient demographics, pre- and post-operative vital signs and laboratory tests, and PRBC:FFP ratio, and their effect on 30-day mortality. Over the 20-year study period, 128 RAAA patients had massive hemorrhage. The authors found the 30-day mortality rate was significantly lower in patients who received blood products at a PRBC:FFP ratio≤2:1, dubbed the high FFP group, compared to those with a PRBC:FFP ratio>2:1, the low FFP group (14.9% vs. 39%, p<0.03). Moreover, the likelihood of death was more than fourfold greater in the low FFP group (odds ratio 4.23, 95% confidence interval 1.23–14.49). Finally, the high FFP group had a lower incidence of colonic ischemia than the low FFP group (22.4% vs. 41.1%, p=0.004).