RT Journal Article
SR Electronic
T1 A mathematical model for fresh frozen plasma transfusion strategies during major trauma resuscitation with ongoing hemorrhage
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 470
OP 478
VO 48
IS 6
A1 Anthony M.H. Ho
A1 Peter W. Dion
A1 Claudia A.Y. Cheng
A1 Manoj K. Karmakar
A1 Gregory Cheng
A1 Zhiyong Peng
A1 Yu Wai Ng
YR 2005
UL http://canjsurg.ca/content/48/6/470.abstract
AB Background: Randomized controlled trials of how best to administer fresh frozen plasma (FFP) in the presence of ongoing severe traumatic hemorrhage are difficult to execute and have not been published. Meanwhile, coagulopathy remains a common occurrence during major trauma resuscitation and hemorrhage remains a major cause of traumatic deaths, suggesting that current coagulation factor replacement practices may be inadequate.Methods: We used a pharmacokinetic model to simulate the dilutional component of coagulopathy during hemorrhage and compared different FFP transfusion strategies for the prevention or correction, or both, of dilutional coagulopathy. Assuming the rates of volume replacement and loss are roughly equal, we derived the hematocrit and plasma coagulation factor concentration over time based on the rate of blood loss and replacement, the hematocrit and coagulation factor concentration of the transfusate, and the hematocrit and plasma factor concentration at the time when FFP transfusion begins.Results: Once excessive deficiency of factors has developed and bleeding is unabated, 1–1.5 units of FFP must be given for every unit of packed red blood cells (PRBC) transfused. If FFP transfusion should start before plasma factor concentration drops below 50% of normal, an FFP:PRBC transfusion ratio of 1:1 would prevent further dilution.Conclusion: During resuscitation of a patient who has undergone major trauma, the equivalent of whole-blood transfusion is required to correct or prevent dilutional coagulopathy.