• Frederick A Moore, Teresa Nelson, Bruce A McKinley, Ernest E Moore, Avery B Nathens, Peter Rhee, Juan Carlos Puyana, Gregory J Beilman, Stephen M Cohn, and StO2 Study Group.
• Department of Surgery, The Methodist Hospital, Houston, TX, USA. famoore@tmh.tmc.edu
• Am. J. Surg. 2008 Dec 1;196(6):948-58; discussion 958-60.

BackgroundDamage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding.MethodsTo ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective traumatic shock database of 383 civilians.ResultsNinety-three (24%) of the traumatic shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated.ConclusionCivilians who arrived in traumatic shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.

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