Is Fresh Frozen Plasma Still Necessary for Management of Acute Traumatic Coagulopathy?
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ANESTHESIA FOR TRAUMA (TE GRISSOM, SECTION EDITOR)
Is Fresh Frozen Plasma Still Necessary for Management of Acute Traumatic Coagulopathy? Giles R. Nordmann 1 & Detlef Obal 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Massive blood loss secondary to major trauma is a leading cause of death worldwide. In recent years, multiple different strategies have evolved to counteract this life-threatening condition. In this review, we will review our understanding of trauma-induced coagulopathy and summarize current clinical transfusion regimes utilized in military and civilian settings. We will review currently available blood products used to rectify the coherent disturbances of haemostasis by outlining the characteristics of the different products. Recent Findings Current evidence suggests that fresh frozen plasma and fibrinogen components play a fundamental role in trauma resuscitation with recent studies suggesting pre-hospital plasma and fibrinogen administration might also be beneficial in counteracting trauma-induced coagulopathy. Based on experience out of combat zones, whole blood transfusion might experience a renaissance in the future. Summary Multiple different plasma-based products are available to treat and prevent trauma-induced coagulation disturbances. As randomized controlled trials in trauma population are difficult to conduct, most of the evidence is currently based on relatively small studies. While the overarching result of our review suggests the early use of plasma and fibrinogen products in combination with packed red blood cells will prevent trauma-induced coagulopathy, large, multi-centre studies are warranted to evaluate the long-term effects on patients’ outcome. Keywords Trauma . Coagulopathy . Fresh frozen plasma . Anaesthesia . Resuscitation
Introduction Massive haemorrhage secondary to trauma is a leading cause of death worldwide necessitating blood component resuscitation. Military and civilian studies have shown an associated survival and morbidity benefit in trauma patients resuscitated with a high ratio of fresh frozen plasma (FFP) to packed red blood cell (PRBC) [1–5] and both European [6•] and North This article is part of the Topical Collection on Anesthesia for Trauma * Detlef Obal [email protected] Giles R. Nordmann [email protected] 1
Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
2
Department of Anesthesiology, Perioperative, and Pain Medicine Cardiovascular Institute, Outcomes Research™, Stanford University, Stanford, CA 94304, USA
American [7] guidelines recommend an equal ratio of FFP to PRBC (and platelets). Some European authors have strongly recommended the initial use of factor concentrates for resuscitation in these casualties, although study results have not been conclusive [7, 8]. The presence of early hypofibrinogenemia in trauma patients is associated with an increased mortality [9], and the administration of fibrinogen concentrate (FC) has been shown to address this as
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