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Blood Product Transfusion

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Utilizing Group-based Trajectory Modeling to Understand Patterns of Hemorrhage and Resuscitation.
Savage SA, Sumislawski JJ, Bell TM, Zarzaur BL.
Ann Surg. 2016 Dec;264(6):1135-1141.

Rationale for inclusion:  The authors conducted a prospective observational study of 316 patients to define 6 distinct transfusion trajectories that are important in clinical course and trajectory.

Citations - 1 (as of July 2017)

Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion.
Heddle NM, Cook RJ, Arnold DM, Liu Y, Barty R, Crowther MA, Devereaux PJ, Hirsh J, Warkentin TE, Webert KE, Roxby D, Sobieraj-Teague M, Kurz A, Sessler DI, Figueroa P, Ellis M, Eikelboom JW.
N Engl J Med. 2016 Nov 17;375(20):1937-1945.

Rationale for inclusion:  Randomized, controlled, multicenter trial comparing outcomes after transfusion of short-term (mean 13d) vs. long-term storage (24d) RBCs.  No difference in hospital mortality was detected between groups.

CAVEAT: Not a trauma but a general hospital population

Citations - 41 (as of July 2017)

Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients.
Yazer MH, Jackson B, Sperry JL, Alarcon L, Triulzi DJ, Murdock AD.
J Trauma Acute Care Surg. 2016 Jul;81(1):21-6.

Rationale for inclusion:  Initial report of safety and feasibility of uncrossed whole blood transfusion in the civilian trauma population.

CAVEAT: Small study

Citations - 11 (as of July 2017)

Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial.
Goldstein JN, Refaai MA, Milling TJ Jr, Lewis B, Goldberg-Alberts R, Hug BA, Sarode R.
Lancet. 2015 May 23;385(9982):2077-87.

Rationale for inclusion: Four-factor PCC is non-inferior and superior to plasma for rapid INR reversal in patients taking vitamin K antagonists.

Citations - 124 (as of July 2017)

Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial.
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, del Junco DJ, Brasel KJ, Bulger EM, Callcut RA, Cohen MJ, Cotton BA, Fabian TC, Inaba K, Kerby JD, Muskat P, O'Keeffe T, Rizoli S, Robinson BR, Scalea TM, Schreiber MA, Stein DM, Weinberg JA, Callum JL, Hess JR, Matijevic N, Miller CN, Pittet JF, Hoyt DB, Pearson GD, Leroux B, van Belle G; PROPPR Study Group.
JAMA. 2015 Feb 3;313(5):471-82.

Rationale for inclusion: PROPPR trial discussed ratios of blood product for resuscitation of trauma patients.

Citations - 442 (as of July 2017)

The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks.
Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA, Alarcon LH, Bai Y, Brasel KJ, Bulger EM, Cotton BA, Matijevic N, Muskat P, Myers JG, Phelan HA, White CE, Zhang J, Rahbar MH; PROMMTT Study Group.
JAMA Surg. 2013 Feb;148(2):127-36.

Rationale for inclusion: Early administration of balanced blood products leads to decreased 6-h mortality.

Citations - 355 (as of July 2017)

Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage.
Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB, Leppaniemi A, Parr M, Vincent JL, Tortella BJ, Dimsits J, Bouillon B; CONTROL Study Group.
J Trauma. 2010 Sep;69(3):489-500.

Rationale for inclusion: Factor VII administration decreased blood product use but did not affect mortality compared with placebo.

Citations - 281 (as of July 2017)

A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study.
Zink KA, Sambasivan CN, Holcomb JB, Chisholm G, Schreiber MA.
Am J Surg. 2009 May;197(5):565-70; discussion 570.

Rationale for inclusion: The early administration of high ratios of FFP and platelets improves survival and decreases overall PRBC need in massively transfused patients. The largest difference in mortality occurs during the first 6 hours after admission, suggesting that the early administration of FFP and platelets is critical.

Citations - 280 (as of July 2017)

The relationship of blood product ratio to mortality: survival benefit or survival bias?
Snyder CW, Weinberg JA, McGwin G Jr, Melton SM, George RL, Reiff DA, Cross JM, Hubbard-Brown J, Rue LW 3rd, Kerby JD.
J Trauma. 2009 Feb;66(2):358-62; discussion 362-4.

Rationale for inclusion: Higher FFP to PRBC ratios at 24h was associated with improved survival; however, in this analysis, association was no longer significant when the timing of component product transfusion was taken into account.

Citations - 360 (as of July 2017)

Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications.
Cotton BA, Au BK, Nunez TC, Gunter OL, Robertson AM, Young PP.
J Trauma. 2009 Jan;66(1):41-8; discussion 48-9.

Rationale for inclusion: Risk of organ failure and high complication rates for patients receiving high ratio of FFP to PRBCs may be mitigated by early administration of products.

Citations - 319 (as of July 2017)

An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion.
Sperry JL, Ochoa JB, Gunn SR, Alarcon LH, Minei JP, Cuschieri J, Rosengart MR, Maier RV, Billiar TR, Peitzman AB, Moore EE; Inflammation the Host Response to Injury Investigators
J Trauma. 2008 Nov;65(5):986-93.

Rationale for inclusion: Higher ratio of FFP to PRBCs associated with lower risk of mortality in patients requiring more than 8 units of PRBCs.

Citations - 330 (as of July 2017)

Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients.
Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, Gonzalez EA, Pomper GJ, Perkins JG, Spinella PC, Williams KL, Park MS.
Ann Surg. 2008 Sep;248(3):447-58.

Rationale for inclusion: Civilian study of massive transfusion supporting a higher  plasma:RBC and higher platelet:rbc ratio is beneficial.

Citations - 900 (as of July 2017)

Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival.
Gunter OL Jr, Au BK, Isbell JM, Mowery NT, Young PP, Cotton BA.
J Trauma. 2008 Sep;65(3):527-34.

Rationale for inclusion: Increased FFP:PRBC and PLT:PRBC ratios during a period of massive transfusion improved survival after major trauma. Massive transfusion protocols should be designed to achieve these ratios to provide maximal benefit.

Citations - 335 (as of July 2017)

Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer?
Kashuk JL, Moore EE, Johnson JL, Haenel J, Wilson M, Moore JB, Cothren CC, Biffl WL, Banerjee A, Sauaia A.
J Trauma. 2008 Aug;65(2):261-70; discussion 270-1.

Rationale for inclusion:  1:1 ratio of FFP to PRBCs reduced coagulopathy but there was no survival benefit in trauma patients undergoing massive transfusion.

Citations - 364 (as of July 2017)

Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years?
Duchesne JC, Hunt JP, Wahl G, Marr AB, Wang YZ, Weintraub SE, Wright MJ, McSwain NE Jr.
J Trauma. 2008 Aug;65(2):272-6; discussion 276-8.

Rationale for inclusion: An FFP to PRBC ratio close to 1:1 confers a survival advantage in patients requiring massive transfusion.

Citations - 315 (as of July 2017)

Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization.
Cotton BA, Gunter OL, Isbell J, Au BK, Robertson AM, Morris JA Jr, St Jacques P, Young PP.
J Trauma. 2008 May;64(5):1177-82; discussion 1182-3.

Rationale for inclusion: Use of a trauma exsanguination protocol (massive transfusion protocol) reduces odds of mortality.

Citations - 381 (as of July 2017)

Fresh frozen plasma should be given earlier to patients requiring massive transfusion.
Gonzalez EA, Moore FA, Holcomb JB, Miller CC, Kozar RA, Todd SR, Cocanour CS, Balldin BC, McKinley BA.
J Trauma. 2007 Jan;62(1):112-9.

Rationale for inclusion: Coagulopathy persists when FFP is not given in high ratios early, suggesting that FFP can be administered early to prevent coagulopathy.

Citations - 538 (as of July 2017)

Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.
Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, Rossaint R, Axelsen M, Kluger Y; NovoSeven Trauma Study Group.
J Trauma. 2005 Jul;59(1):8-15; discussion 15-8.

Rationale for inclusion: Describes use of factor VIIa in trauma, decreases RBC transfusions.

Citations - 746 (as of July 2017)

Blood transfusion, independent of shock severity, is associated with worse outcome in trauma.
Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM.
J Trauma. 2003 May;54(5):898-905; discussion 905-7.

Rationale for inclusion: Blood transfusion is confirmed as an independent predictor of mortality, ICU admission, ICU LOS, and hospital LOS in trauma after controlling for severity of shock by admission base deficit, lactate, shock index, and anemia. 

Citations - 586 (as of July 2017)

Age of transfused blood is an independent risk factor for postinjury multiple organ failure.
Zallen G, Offner PJ, Moore EE, Blackwell J, Ciesla DJ, Gabriel J, Denny C, Silliman CC.
Am J Surg. 1999 Dec;178(6):570-2.

Rationale for inclusion: Age of transfused blood (PRBCs) given in the first 6 hours is an independent risk factor for multiple organ failure.

Citations - 498 (as of July 2017)

Outcome after hemorrhagic shock in trauma patients.
Heckbert SR, Vedder NB, Hoffman W, Winn RK, Hudson LD, Jurkovich GJ, Copass MK, Harlan JM, Rice CL, Maier RV.
J Trauma. 1998 Sep;45(3):545-9.

Rationale for inclusion: Study showing that hemorrhagic shock and need for resuscitation was predictive of high mortality and morbidity.

Citations - 357 (as of July 2017)

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