R. Ball1,2, J. S. Vazquez1,2, T. E. Travis1,2,3, M. M. McLawhorn2, L. S. Johnson1,2,3, L. T. Moffatt2,4, J. W. Shupp1,2,3,4 1MedStar Washington Hospital Center,The Burn Center,Washington, DC, USA 2MedStar Health Research Institute,Firefighters’ Burn And Surgical Research Laboratory,Washington, DC, USA 3Georgetown University School of Medicine,Department Of Surgery,Washington, DC, USA 4Georgetown University School of Medicine,Department Of Biochemistry,Washington, DC, USA
Introduction: Burn shock frequently occurs in patients with large cutaneous thermal injuries. Vasodilation, vasoplegia, and capillary leak each contribute to a decrease in end organ perfusion seen in these patients. Restoration of cardiac output and correction of end organ malperfusion has traditionally been achieved by large-volume crystalloid fluid administration, although this can lead to edema-related complications. Colloid inclusive resuscitations (CIR) have been described using either human albumin (HA) or fresh frozen plasma (FFP). Both HA and FFP can be useful in restoring intravascular volume and reducing edema formation. However, FFP has been linked to various transfusion reactions including acute hemolytic transfusion reaction (AHTR), transfusion related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), and allergic transfusion reactions (ATR). A single burn center’s use of FFP during burn shock resuscitation was evaluated over a two year period with respect to the incidence of these reactions.
Methods: Patients with large thermal cutaneous injuries and burn shock who received FFP for the resuscitation from July 2016 to July 2018 were identified for review. The electronic medical records were queried to collect demographic, laboratory, and mortality data. Signs and symptoms of TRALI were defined by the Canadian Blood Services Consensus Conference. The primary outcome of interest was the frequency of transfusion related reactions.
Results:A total of 46 patients were identified as having large thermal cutaneous injuries and received treatment with FFP for burn resuscitation.Twenty patients met criteria for having an alternate etiology of acute lung injury (ALI), such as concomitant inhalation injury and/or blunt trauma to the chest; these were excluded from the analysis. The remaining twenty-six patients had a mean age of 51.2 years; 57.1% were male. The average TBSA involved was 31.6%. Flame burns (82.1%) were the most common mechanism of injury seen in this patient population. Patients received a mean IV fluid volume of 6.7cc/kg/%TBSA during the first 24 hours after injury. Of the patients that did receive FFP during the initial 24 hours, the average start time of FFP infusion was 12.7 hours after injury. Patients received a mean of 21 units of FFP, with a total of 535 units of FFP administered between all 26 patients. No patients were identified as having any signs and symptoms of any acute transfusion reaction associated with FFP administration.
Conclusion: Patients admitted to this regional burn center with large thermal cutaneous injuries generally receive FFP administration as part of the burn resuscitation. Although there are reports describing adverse impacts of FFP administration in this patient population, these were not observed in the study. A multicenter randomized prospective observational study is warranted to adequately evaluate the risk benefit of using HA or FFP during a burn resuscitation.