Aoki Makoto, Fukushima Kazunori, Hayakawa Mineji, Kudo Daisuke, Tagami Takashi, Oshima Kiyohiro, Kushimoto Shigeki
Division of Traumatology, Research Institute National Defense Medical College Saitama Japan.
Department of Emergency Medicine Gunma University Graduate School of Medicine Maebashi Gunma Japan.
Acute Med Surg. 2024 Nov 5;11(1):e70016. doi: 10.1002/ams2.70016. eCollection 2024 Jan-Dec.
A balanced transfusion strategy has been a standard resuscitation method for trauma patients, and adherence to a massive transfusion protocol incorporating balanced transfusion is reported to reduce mortality. This study aimed to assess adherence to balanced transfusion among severely injured patients in Japan.
This study analyzes RESTRIC (restrictive transfusion strategy for critically injured patients) trial patients who were cluster-randomized based on restrictive or liberal transfusion strategy. We defined two transfusion groups: massive transfusion group 1, which includes RBC transfusions of at least eight units within 6 h; and massive transfusion group 2, which includes RBC transfusions of at least 20 units within 24 h. Adherence to balanced transfusion was assessed as the ratios of fresh frozen plasma (FFP) to red blood cells (RBC) and platelet concentrate (PC) to RBC ratio >0.5.
Among 220 eligible patients, 98 (44.5%) were grouped as massive transfusion group 1 and 38 (17.3%) as massive transfusion group 2. The balanced transfusion in terms of the FFP to RBC ratio was nearly 100% for groups 1 and 2 over all periods. However, the balanced transfusion in terms of the PC to RBC ratio within 6 h were 51.0% for group 1 and 68.4% for group 2.
This study revealed that while the ratio of FFP to RBC was balanced among patients from the early phase, the ratio of PC to RBC was not fully balanced, particularly in the early phase.
平衡输血策略一直是创伤患者的标准复苏方法，据报道，遵循包含平衡输血的大量输血方案可降低死亡率。本研究旨在评估日本重伤患者对平衡输血的遵循情况。
本研究分析了基于限制性或宽松输血策略进行整群随机分组的RESTRIC（重症创伤患者限制性输血策略）试验患者。我们定义了两个输血组：大量输血组1，包括在6小时内输注至少8单位红细胞；大量输血组2，包括在24小时内输注至少20单位红细胞。将新鲜冰冻血浆（FFP）与红细胞（RBC）的比率以及血小板浓缩物（PC）与RBC的比率>0.5评估为对平衡输血的遵循情况。
在220例符合条件的患者中，98例（44.5%）被归为大量输血组1，38例（17.3%）被归为大量输血组2。在所有时间段内，两组的FFP与RBC比率方面的平衡输血率接近100%。然而，在6小时内，组1的PC与RBC比率方面的平衡输血率为51.0%，组2为68.4%。
本研究表明，虽然早期患者中FFP与RBC的比率是平衡的，但PC与RBC的比率并未完全平衡，尤其是在早期阶段。
