ArticleThe journal of trauma and acute care surgery2012
Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way.
Article in The journal of trauma and acute care surgery, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
35 citing papers in PubMed, 4 syntheses or guidelines pooled it, 131 citations in OpenAlex.
- Prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Prehospital Blood Product Resuscitation for Trauma: A Systematic Review.Shock (Augusta, Ga.) · 2016Pooled it
- Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis.Critical care (London, England) · 2013Pooled it
- Is non-operative management safe and effective for all splenic blunt trauma? A systematic review.Critical care (London, England) · 2013Pooled it
- Risk Factors for the Development of Acute Respiratory Distress Syndrome Following Hemorrhage.Shock (Augusta, Ga.) · 2018Trial
- Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial.Prehospital emergency careTrial
- Increased prehospital to total blood product administration associated with improved hospital outcomes: A secondary analysis of hemorrhagic shock trials.The journal of trauma and acute care surgery · 2026Article
- Time-limited association between plasma transfusion and mortality in pediatric traumatic brain injury.The journal of trauma and acute care surgery · 2025Article
- Impact of Early Plasma Resuscitation in Pediatric Severe Traumatic Brain Injury.Journal of pediatric surgery · 2025Article
- How do we forecast tomorrow's transfusion? Prehospital transfusion.Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine · 2023Article
- Article
- Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review.Life (Basel, Switzerland) · 2022Review
- Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years' Experience.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2021Review
- The Evolution of Blood Product Use in Trauma Resuscitation: Change Has Come.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2021Article
- Trauma-induced coagulopathy.Nature reviews. Disease primers · 2021Review
- Bicarbonate Ringer's solution for early resuscitation in hemorrhagic shock rabbits.Annals of translational medicine · 2021Article
- Analysis of polymorphonuclear cell apoptosis and inflammatory cytokines in trauma patients in the emergency department.American journal of translational research · 2021Article
- Damage control resuscitation.Clinical and experimental emergency medicine · 2020Article
- Platelet transfusion increases risk for acute respiratory distress syndrome in non-massively transfused blunt trauma patients.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2019Article
- Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid.Scandinavian journal of trauma, resuscitation and emergency medicine · 2018Observational
Corrections and comments
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Authors and funding
11 authors at 8 institutions in 1 country.
Funding
Abstract
backgroundMassive transfusion (MT) protocols have emphasized the importance of ratio-based transfusion of plasma and platelets relative to packed red blood cells (PRBCs); however, the risks attributable to crystalloid resuscitation in patients requiring MT remain largely unexplored. We hypothesized that an increased crystalloid:PRBC (C:PRBC) ratio would be associated with increased morbidity and poor outcome after MT.
methodsData were obtained from a multicenter prospective cohort study evaluating outcomes in blunt injured adults with hemorrhagic shock. Patients requiring MT (≥ 10 units PRBCs in first 24 hours) were analyzed. The C:PRBC ratio was computed by the ratio of crystalloid infused in liters (L) to the units of PRBCs transfused in the first 24 hours postinjury. Logistic regression modeling was used to characterize the independent risks associated with the 24-hour C:PRBC ratio, after controlling for important confounders and other blood component transfusion requirements.
resultsLogistic regression revealed that the 24-hour C:PRBC ratio was significantly associated with a greater independent risk of multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), and abdominal compartment syndrome (ACS). No association with mortality or nosocomial infection was found. A dose-response analysis revealed that patients with a C:PRBC ratio >1.5:1 had over a 70% higher independent risk of MOF and over a twofold higher risk of ARDS and ACS.
conclusionIn patients requiring MT, crystalloid resuscitation in a ratio greater than 1.5:1 per unit of PRBCs transfused was independently associated with a higher risk of MOF, ARDS, and ACS. These results suggest overly aggressive crystalloid resuscitation should be minimized in these severely injured patients. Further research is required to determine whether incorporation of the C:PRBC ratio into MT protocols improves outcome.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.