The Ratio of Fibrinogen to Red Cells Transfused Affects Survival in Casualties Receiving Massive Transfusions at an Army Combat Support Hospital

Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of cryoprecipitate as a source of fibrinogen. Our objective was to determine whether increased ratios of fibrinogen to red blood cells (RBCs) decreased mortality in combat casualties requiring massive trans...

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Main Authors: Stinger, Harry K, Spinella, Philip C, Perkins, Jeremy G, Grathwohl, Kurt W, Salinas, Jose, Martini, Wenjun Z, Hess, John R, Dubick, Michael A, Simon, Clayton D, Beekley, Alec C
Format: Report
Language:English
Subjects:
BLOOD COAGULATION
BLOOD TRANSFUSION
CASUALTIES
COAGULOPATHY
CRYOPRECIPITATE
DEATH
ERYTHROCYTES
FIBRINOGEN
MASSIVE TRANSFUSION
Medicine and Medical Research
MORTALITY
RATIOS
RBC(RED BLOOD CELLS)
REPRINTS
SURVIVAL(PERSONNEL)
TRAUMA
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Summary:Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of cryoprecipitate as a source of fibrinogen. Our objective was to determine whether increased ratios of fibrinogen to red blood cells (RBCs) decreased mortality in combat casualties requiring massive transfusion. Methods: We performed a retrospective chart review of 252 patients at a U.S. Army combat support hospital who received a massive transfusion (10 units of RBCs in 24 hours). The typical amount of fibrinogen within each blood product was used to calculate the fibrinogen-to-RBC (F:R) ratio transfused for each patient. Two groups of patients who received either a low (0.2 g fibrinogen/RBC Unit) or high (0.2 g fibrinogen/RBC Unit) F:R ratio were identified. Mortality rates and the cause of death were compared between these groups, and logistic regression was used to determine if the F:R ratio was independently associated with survival. Conclusions: In patients with combat-related trauma requiring massive transfusion, the transfusion of an increased fibrinogen: RBC ratio was independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage. Prospective studies are needed to evaluate the best source of fibrinogen and the optimal empiric ratio of fibrinogen to RBCs in patients requiring massive transfusion. Pub. in The Journal of Trauma: Injury, Infection, and Critical Care, v64 n2 pS79-S85, Feb Supplement 2008.