TY - JOUR
T1 - Impact of high ratios of plasmaytoyred cell concentrate on the incidence of acute respiratory distress syndrome in uk transfused combat casualties
AU - Starkey, Kerry
AU - Keene, Damian
AU - Morrison, Jonathan James
AU - Doughty, Heidi
AU - Midwinter, Mark J.
AU - Woolley, Tom
AU - Jansen, Jan Olaf
PY - 2013/7
Y1 - 2013/7
N2 - Trauma transfusion strategies, which incorporate balanced red-cell concentrate (RCC)YtoYfresh frozen plasma (FFP) ratios, may be associated with improved survival in massively transfused patients. However, the use of this approach in nonmassively transfused patients has led to concern regarding an increase in acute respiratory distress syndrome (ARDS). The aim of this study was to assess the incidence of ARDS in transfused UK military casualties. All UK military casualties receiving an RCC transfusion within a 16-month period were identified from the UK Trauma Registry, and chest radiographs retrieved. If bilateral infiltrates were present, case notes were retrieved to calculate the PaO2/FIO2 ratio in accordance with the American-European Consensus Conference criteria. Patients were divided into massively transfused (10 U/24 h) and nonmassively transfused (<10 U/24 h) receiving a high ratio (0.75) or low (<0.75) RCC:FFP ratio. The primary outcome was the development of ARDS within 7 days of transfusion. Primary blast lung injury was excluded. Of 145 patients identified, 144 had records available for analysis with a median injury severity score of 21. The majority were injured by explosion (76%), and the remainder by gunshot (24%). There were 60 nonmassively transfused patients with 18 in the low and 42 in the high RCC:FFP ratio groups. Of the remaining 80 massively transfused patients, 11 were in the low and 73 were in the high-ratio groups. There was no difference in the incidence of ARDS between low- and high-ratio groups in either nonmassively transfused (22.2% vs. 9.5%; P = 0.232) or massively transfused (18.2% vs. 23.3%; P = 1.000) casualties. There was no statistically significant increase in the incidence of ARDS in UK casualties treated with high, compared with low, ratios of plasma to RCC.
AB - Trauma transfusion strategies, which incorporate balanced red-cell concentrate (RCC)YtoYfresh frozen plasma (FFP) ratios, may be associated with improved survival in massively transfused patients. However, the use of this approach in nonmassively transfused patients has led to concern regarding an increase in acute respiratory distress syndrome (ARDS). The aim of this study was to assess the incidence of ARDS in transfused UK military casualties. All UK military casualties receiving an RCC transfusion within a 16-month period were identified from the UK Trauma Registry, and chest radiographs retrieved. If bilateral infiltrates were present, case notes were retrieved to calculate the PaO2/FIO2 ratio in accordance with the American-European Consensus Conference criteria. Patients were divided into massively transfused (10 U/24 h) and nonmassively transfused (<10 U/24 h) receiving a high ratio (0.75) or low (<0.75) RCC:FFP ratio. The primary outcome was the development of ARDS within 7 days of transfusion. Primary blast lung injury was excluded. Of 145 patients identified, 144 had records available for analysis with a median injury severity score of 21. The majority were injured by explosion (76%), and the remainder by gunshot (24%). There were 60 nonmassively transfused patients with 18 in the low and 42 in the high RCC:FFP ratio groups. Of the remaining 80 massively transfused patients, 11 were in the low and 73 were in the high-ratio groups. There was no difference in the incidence of ARDS between low- and high-ratio groups in either nonmassively transfused (22.2% vs. 9.5%; P = 0.232) or massively transfused (18.2% vs. 23.3%; P = 1.000) casualties. There was no statistically significant increase in the incidence of ARDS in UK casualties treated with high, compared with low, ratios of plasma to RCC.
KW - Acute lung injury
KW - Acute respiratory distress syndrome
KW - Damage control resuscitation
KW - Hemostatic resuscitation
KW - Transfusion-related acute lung injury
UR - http://www.scopus.com/inward/record.url?scp=84880073327&partnerID=8YFLogxK
U2 - 10.1097/SHK.0b013e3182991f37
DO - 10.1097/SHK.0b013e3182991f37
M3 - Article
C2 - 23649100
AN - SCOPUS:84880073327
SN - 1073-2322
VL - 40
SP - 15
EP - 20
JO - Shock
JF - Shock
IS - 1
ER -