TY - JOUR
T1 - Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion
T2 - Results from a Systematic Review
AU - McQuilten, Zoe K.
AU - Crighton, Gemma
AU - Brunskill, Susan J
AU - Morison, Jessica K.
AU - Richter, Tania H.
AU - Waters, Neil
AU - Murphy, Michael F.
AU - Wood, Erica M.
PY - 2017/7/6
Y1 - 2017/7/6
N2 - Optimal dose, timing and ratio to red blood cells (RBC) of blood component therapy (fresh frozen plasma [FFP], platelets, cryoprecipitate or fibrinogen concentrate) to reduce morbidity and mortality in critically bleeding patients requiring massive transfusion is unknown. We performed a systematic review for randomized controlled trials (RCT) in MEDLINE, The Cochrane Library, Embase, CINAHL, PubMed the Transfusion Evidence Library and using multiple clinical trials registries to 21 February 2017. Sixteen RCTs were identified: six completed (five in adult trauma patients, one pediatric burn patients) and ten ongoing trials. Of the completed trials: three were feasibility trials, comparing a FFP, platelets and RBC ratio of 1:1:1 to laboratory-guided transfusion practice [n = 69], early cryoprecipitate compared to standard practice [n = 41], and early fibrinogen concentrate compared to placebo [n = 45]; one trial compared the effect of FFP, platelets and RBC ratio of 1:1:1 with 1:1:2 on 24-hour and 30-day mortality [n = 680]; one compared whole blood to blood component therapy on 24-hour blood use [n = 107]; one compared a FFP to RBC ratio of 1:1 with 1:4 [n = 16]. Data from two trials were pooled in a meta-analysis for 28-day mortality because the transfusion ratios achieved were similar. Results from these two trials suggest higher transfusion ratios were associated with transfusion of more FFP and platelets without evidence of significant difference with respect to mortality or morbidity. On the limited evidence available, there is insufficient basis to recommend a 1:1:1 over a 1:1:2 ratio or standard care for adult patients with critical bleeding requiring massive transfusion.
AB - Optimal dose, timing and ratio to red blood cells (RBC) of blood component therapy (fresh frozen plasma [FFP], platelets, cryoprecipitate or fibrinogen concentrate) to reduce morbidity and mortality in critically bleeding patients requiring massive transfusion is unknown. We performed a systematic review for randomized controlled trials (RCT) in MEDLINE, The Cochrane Library, Embase, CINAHL, PubMed the Transfusion Evidence Library and using multiple clinical trials registries to 21 February 2017. Sixteen RCTs were identified: six completed (five in adult trauma patients, one pediatric burn patients) and ten ongoing trials. Of the completed trials: three were feasibility trials, comparing a FFP, platelets and RBC ratio of 1:1:1 to laboratory-guided transfusion practice [n = 69], early cryoprecipitate compared to standard practice [n = 41], and early fibrinogen concentrate compared to placebo [n = 45]; one trial compared the effect of FFP, platelets and RBC ratio of 1:1:1 with 1:1:2 on 24-hour and 30-day mortality [n = 680]; one compared whole blood to blood component therapy on 24-hour blood use [n = 107]; one compared a FFP to RBC ratio of 1:1 with 1:4 [n = 16]. Data from two trials were pooled in a meta-analysis for 28-day mortality because the transfusion ratios achieved were similar. Results from these two trials suggest higher transfusion ratios were associated with transfusion of more FFP and platelets without evidence of significant difference with respect to mortality or morbidity. On the limited evidence available, there is insufficient basis to recommend a 1:1:1 over a 1:1:2 ratio or standard care for adult patients with critical bleeding requiring massive transfusion.
KW - Cryoprecipitate
KW - Fresh frozen plasma
KW - Hemorrhage
KW - Platelet transfusion
KW - Red blood cell transfusion
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85028346938&partnerID=8YFLogxK
U2 - 10.1016/j.tmrv.2017.06.003
DO - 10.1016/j.tmrv.2017.06.003
M3 - Article
C2 - 28803752
AN - SCOPUS:85028346938
VL - 32
SP - 6
EP - 15
JO - Transfusion Medicine Reviews
JF - Transfusion Medicine Reviews
SN - 0887-7963
IS - 1
ER -