B-164 Impact of Plasma-to-Red Blood Cell Ratio on Outcomes in Trauma Patients: A Retrospective Analysis of Different Trauma Mechanisms

Abstract Background Understanding the trauma mechanism is vital for effective triage in the emergency room (ER), as it influences the strategic approach to blood component transfusion. Theoretical assumptions suggest that different trauma mechanisms necessitate varied transfusion strategies, particularly the ratio of fresh frozen plasma (FFP) to packed red blood cells (pRBC). However, the implications of varying FFP-to-pRBC ratios on patient outcomes, particularly in relation to specific injury mechanisms, remain inadequately explored. This study aims to determine the influence of early administration of a high plasma-to-red blood cell ratio on the clinical outcomes of trauma patients categorized by the nature of their injuries. Methods This single-center retrospective study evaluated trauma patients treated from 2015 to 2023. We identified 223 patients with severe bleeding post-trauma who met the inclusion criteria: aged 18 to 80 years, activation of the trauma team, involvement in a specified trauma mechanism, deceased before initial intervention in the ER, and receipt of massive transfusion (=8 units of packed red blood cells and related blood products, including whole blood) within the first 24 hours post-injury. Patients were categorized into blunt or penetrating trauma groups and further subdivided based on their transfusion ratios: a high-ratio group (FFP-to-pRBC ratio >1:1.5) and a low-ratio group (FFP-to-pRBC ratio =1:1.5). Results Out of 1,761 patients with trauma team activations, 222 met the study criteria. Of these, 191 patients experienced blunt trauma (107 in the high-ratio group and 84 in the low-ratio group), and 31 suffered penetrating trauma (17 in the high-ratio group and 14 in the low-ratio group). The comparative analysis focused on vital signs, international normalized ratio (INR), injury severity score (ISS), and initial hemoglobin levels. The mortality rates were statistically similar between the high-ratio and low-ratio groups across trauma types. Notably, in the blunt trauma category, patients in the high-ratio group showed a significantly increased incidence of respiratory failure. Conclusion The study suggests that while a higher FFP-to-pRBC ratio does not appear to affect overall survival, it may contribute to a heightened risk of respiratory complications in patients with blunt trauma. These findings underscore the need for further research to optimize transfusion strategies tailored to specific trauma mechanisms, potentially improving clinical outcomes.