Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, Otsuno, Tsuchiura, Japan.
Crit Care Med. 2022 Oct 1;50(10):1477-1485. doi: 10.1097/CCM.0000000000005596. Epub 2022 Jul 17.
The effectiveness of cryoprecipitate (Cryo) in trauma has not been well established; the benefits of Cryo might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. We aimed to evaluate the benefits of the concurrent use of Cryo in combination with fresh frozen plasma (FFP) for bleeding trauma patients.
Retrospective cohort study.
The American College of Surgeons Trauma Quality Improvement Program database between 2015 and 2019.
Patients who received greater than or equal to 5 units of packed RBCs and at least 1 unit of FFP within the first 4 hours after arrival to a hospital were included and dichotomized according to whether Cryo was used within the first 4 hours of hospital arrival.
None.
The outcomes of patients treated with Cryo and FFP were compared with those treated with FFP only using propensity score-matching analysis. The dose of administered clotting factors in each group was balanced. The primary outcome was inhospital mortality, and the secondary outcome was the occurrence rate of adverse events. A total of 24,002 patients (Cryo+FFP group: 6,018; FFP only group: 17,984) were eligible for analysis, of whom 4,852 propensity score-matched pairs were generated. Significantly lower inhospital mortality (1,959 patients [40.4%] in the Cryo+FFP group vs 2,142 patients [44.1%] in the FFP only group; odds ratio [OR], 0.86; 95% CI, 0.79-0.93) was observed in the Cryo+FFP group; no significant difference was observed in the occurrence rate of adverse events (1,857 [38.3%] vs 1,875 [38.6%]; OR, 1.02; 95% CI, 0.94-1.10). Several sensitivity analyses showed similar results.
Cryo use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients. Future randomized controlled trials are warranted to confirm these results.
在创伤中，冷沉淀（Cryo）的疗效尚未得到充分证实；由于未考虑给予的凝血因子总量的差异，之前的研究可能高估了 Cryo 的益处。我们旨在评估在出血性创伤患者中同时使用冷沉淀（Cryo）联合新鲜冷冻血浆（FFP）的益处。
回顾性队列研究。
美国外科医师学院创伤质量改进计划数据库，2015 年至 2019 年。
纳入在到达医院后 4 小时内接受大于或等于 5 个单位浓缩红细胞和至少 1 个单位 FFP 的患者，并根据在到达医院的前 4 小时内是否使用 Cryo 将其分为两组。
无。
使用倾向评分匹配分析比较接受 Cryo 和 FFP 治疗的患者与仅接受 FFP 治疗的患者的结果。两组给予的凝血因子剂量平衡。主要结局是院内死亡率，次要结局是不良事件发生率。共纳入 24002 名患者（Cryo+FFP 组：6018 名；FFP 仅组：17984 名），其中 4852 对进行了倾向评分匹配。在 Cryo+FFP 组，院内死亡率显著降低（Cryo+FFP 组 1959 例[40.4%]，FFP 仅组 2142 例[44.1%]；比值比[OR]，0.86；95%置信区间[CI]，0.79-0.93）；不良事件发生率无显著差异（Cryo+FFP 组 1857 例[38.3%]，FFP 仅组 1875 例[38.6%]；OR，1.02；95%CI，0.94-1.10）。几项敏感性分析显示了相似的结果。
Cryo 联合 FFP 的使用与出血性创伤患者的死亡率降低显著相关。需要进一步的随机对照试验来证实这些结果。
