“Spillover” of Transfusion Practice from Trauma to Non-trauma Patients Without Strong Supporting Evidence

MedicalResearch.com Interview with:

Daniel Dante Yeh, MD FACC Assistant Professor of Surgery Harvard Medical School Course Director General/GI Surgery sub-internship Associate Course Director, Surgery Core Clerkship Associate Director, Surgical Intensive Care Unit Co-Director, Nutrition Support Unit Department of Surgery Division of Trauma, Massachusetts General Hospital Emergency Surgery, and Surgical Critical Care Boston, MA 02114

Dr. Yeh

Daniel Dante Yeh, MD FACC
Assistant Professor of Surgery Harvard Medical School Course Director
General/GI Surgery sub-internship Associate Course Director, Surgery Core Clerkship Associate Director, Surgical Intensive Care Unit Co-Director, Nutrition Support Unit Department of Surgery Division of Trauma,
Massachusetts General Hospital
Emergency Surgery, and Surgical Critical Care Boston, MA 02114

MedicalResearch.com: What is the background for this study? 

Response: High Fresh Frozen Plasma to Red Blood Cells FFP:RBC transfusion ratio is a strategy which has emerged in the trauma literature as the preferred method of resuscitation for massively bleeding injured patients.  However, this strategy has now spread to other patient populations which have never been formally studied.   These populations include elective operations and even non-surgical patients.  Giving excess FFP when it is not needed is not only wasteful, but may be harmful, as other studies have reported that FFP can cause problems with lung function, heart function, and immune function.

MedicalResearch.com: What are the main findings?

Response: The main findings of our study are:

1) The practice of high Fresh Frozen Plasma to Red Blood Cells transfusion ratio resuscitation is being practiced in non-trauma patients, which account for the vast majority of massive transfusions at our hospital;

2) We did not find evidence of mortality benefit (with the exception of vascular surgery) associated with high FFP:RBC transfusion ratio in non-trauma patients.  Some subgroups (Medicine and General Surgery) had evidence of a harmful association between high FFP:RBC transfusion ratio and mortality.

MedicalResearch.com: What should readers take away from this report?

Response: There is a “spillover” of transfusion practice from trauma patients to non-trauma patients without strong supporting evidence.  This is important because non-trauma patients account for the vast majority of massive transfusions at our hospital.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Because trauma patients are different from other bleeding patients, it is not appropriate to assume that other patient populations will have the same benefit from the transfusion strategy.  I recommend that formal studies comparing different FFP:RBC transfusion ratios in a randomized fashion be performed to test the hypothesis that high FFP:RBC transfusion is superior to low FFP:RBC transfusion in various non-trauma patient populations.

I have no disclosures (nor do any of my co-authors).

Citation

Mesar T, Larentzakis A, Dzik W, Chang Y, Velmahos G, Yeh DD. Association Between Ratio of Fresh Frozen Plasma to Red Blood Cells During Massive Transfusion and Survival Among Patients Without Traumatic Injury. JAMA Surg. Published online March 08, 2017. doi:10.1001/jamasurg.2017.0098

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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