The Transfusion Timing of Plasma and Red Blood Cells in a 1 : 1 Ratio Is Related with Survival and Functional Outcomes in Multiple Trauma Patients with Severe Traumatic Brain Injury.

objectiveHigh-ratio plasma transfusion is proposed as a strategy for treating polytrauma with severe traumatic brain injury (TBI). This study analyzed outcomes based on the ratio and timing of plasma transfusion.

methodsThe clinical characteristics and results were collected from March 2016 to December 2022. Subjects included patients with severe TBI and polytrauma who underwent massive transfusion (MT). Severe TBI was defined as head abbreviated injury score (AIS) ≥3, and MT was defined as packed red blood cells (pRBCs) ≥4 units in the first 4 hours and ≥10 units in the first 24 hours. The 4-hour ratios were assigned to the "early group," and the 24-hour ratios to the "catch-up group." Next, the ratio of each group was divided into "≥1 : 1 (plasma ≥ pRBC)" and "<1 : 1 (plasma < pRBC)" groups, respectively.

resultsIn this study, 532 patients participated. Mortality rates between the 1 : 2 and 1 : 1.5 ratios did not differ statistically; however, a significant difference was noted only at the 1 : 1 ratio (p=0.006). In the early group, outcomes did not significantly differ. The logistic regression for 30-day mortality identified independent risk factors, including advanced age, low Glasgow coma scale (GOS) scores, high AIS head scores, and a ratio <1 : 1. For the catch-up group, the odds ratio for a favorable GOS at ≥1 : 1 was 1.61, with a 30-day mortality rate of 0.60 when comparing ≥1 : 1 to <1 : 1 ratios.

conclusionThis study showed that maintaining a ≥1 : 1 plasma ratio for 24 hours improved functional outcomes and survival, without increased morbidity. Therefore, high-ratio plasma transfusion may be effective in the treatment of patients with polytrauma and severe TBI.