Investigating the association between initial blood product transfusion with a higher plasma-to-red blood cell ratio and mortality in adults with severe bleeding following trauma.

Trauma patients presenting with massive bleeding require significant blood transfusions to restore circulation and achieve hemostasis. The ratio of fresh-frozen plasma (FFP) to packed red blood cells (PRBC) is critical in determining immediate outcomes and mortality in these patients. This study aims to evaluate the impact of a high FFP:PRBC ratio on 24-hour and 30-day mortality among trauma patients with massive bleeding. In this retrospective descriptive study, inclusion criteria involved adults aged 18 or older presenting with massive trauma-related bleeding within 6 hours after trauma. Patients were categorized into two groups based on the FFP:PRBC ratio: high ratio (>1:1.5) or low ratio (<1:1.5) for damage control resuscitation. Data on demographic characteristics, mortality, intensive care unit (ICU) admission, length of hospital stay, and need for mechanical ventilation were collected. The primary outcomes were 24-hour and 30-day mortality, while secondary outcomes included ICU admission, mechanical ventilation duration, and hospital stay length. A Chi-square test was used to evaluate the association betweena high FFP:PRBC ratio and 24-hour and 30-day mortality. The Mann-Whitney test was used to analyze secondary outcomes. Among 300 patients with a mean age of 40.5 years, 231 (76.7%) were male, and 69 (22.9%) were female. The high FFP:PRBC ratio group showed significantly higher rates of 24-hour mortality (11.5%), 30-day mortality (45.9%), and ICU admission (P < 0.001). However, the mean duration of mechanical ventilation in the high ratio group was 3.36 ± 2.85 days, indicating that some patients in this group still required ventilatory support. This study demonstrates that a high FFP:PRBC ratio (>1:1.5) is associated with reduced 24-hour and 30-day mortality rates among trauma patients with massive hemorrhage. However, the need for mechanical ventilation in some high-ratio patients suggests potential trade-offs that warrant further investigation. Additional research is needed to explore the potential adverse effects of high FFP:PRBC ratios and to optimize transfusion strategies in trauma care.