Safety and Efficacy of an Early Low-Dose Fresh Frozen Plasma Infusion in Burn Resuscitation

Growing evidence supports the addition of fresh frozen plasma (FFP) to a standardized crystalloid-based burn resuscitation. FFP is thought to mitigate endotheliopathy, decrease total fluids and improve outcomes; however, when and how much FFP to give remains controversial. Here, we assessed the safety and efficacy of adding a non-titratable, 8-hour FFP infusion of 0.5 mL/kg/% total body surface area (TBSA) to a burn resuscitation. We performed an unmatched retrospective cohort review on all burn patients aged >18 years old with >20% TBSA burns who underwent our nursing-driven resuscitation protocol that included this early, standardized FFP infusion, from November 2016-May 2020. Fifty-three patients received FFP and met inclusion criteria. Patients were primarily male (85%), with a median age 36 years and a TBSA burn of 39% (range 24.5-94%). Median time to FFP administration was 7 hours from injury with a median of 1517 ml infused. Median input/output (I/O) ratio improved from 0.8 at FFP initiation to 0.4 at 3 hours post FFP, p<0.001. Median urine output (UOP) improved from 0.19 ml/kg/hr prior to FFP administration to 0.52 ml/kg/hr at 3 hours post FFP, p<0.001. No complications related to resuscitation such as abdominal compartment syndrome, acute respiratory distress syndrome, or transfusion reactions occurred. Therefore, adding a low-dose, standardized FFP infusion to burn resuscitations significantly improved UOP, normalized I/O ratios and did not cause any known complications. Standardizing a safe, effective, non-titratable FFP infusion provides the framework to systematically test how colloids can be optimized during burn resuscitations in the future.