• Steven A Kahn, Mallorie L Huff, Justin Taylor, Keisha O'Neill, Ashley B Hink, Rohit Mittal, Andrew Bright, and Prabhakar Baliga.
• The South Carolina Burn Center, Medical University of South Carolina, Department of Surgery, Division of Burn Surgery, 95 Johnathan Lucas Street, #613 Suite 420, Charleston, SC.
• J. Am. Coll. Surg. 2025 Feb 4.

BackgroundFresh frozen plasma (FFP) as an adjunct in burn resuscitation to decrease endothelial cell permeability by restoring the glycocalyx is not yet standard of care, despite increasing evidence showing tis benefits. We hypothesize that utilizing an adjusted body weight index and starting resuscitation at a low rate of 2cc/kg/%TBSA with early plasma results in less fluid administration and superior clinical outcomes compared to traditional resuscitation methods such as Parkland formula.Study DesignThis was a retrospective comparative study of burn patients (>20%TBSA) resuscitated with 2cc/kg/%TBSA LR using their ABWI, early FFP, plus rescue FFP PRN oliguria. ABWI=ideal weight+0.3 [actual weight-ideal weight]. Patients with >30% TBSA were given 1-2UFFP at admission. Fluids were titrated 10-20%/hr. based on UOP. If oliguric for 2-hours, patients received 1-2U "rescue" FFP. Legacy groups were resuscitated with Parkland Formula ("4cc/kg" Group) or a less restrictive 3cc/kg ABWI Group w/rescue FFP only. Demographics, injury characteristics, fluids administered during resuscitation, UOP, outcomes, and death were recorded. Legacy groups were compared to the "2cc/kg+FFP" ABWI group.ResultsPatients given 2cc/kg+FFP received significantly less fluid than the 3 and 4cc groups (1.7 vs 3.3 (p<0.05) vs 4.15 cc/kg/%TBSA (p<0.0001). Urine output was significantly reduced from 1.4 to 1 to 0.7 cc/kg/hr (p<0.0001), approaching goal of 0.5cc/kg/hr. Mortality, mechanical ventilation, tracheostomy, and hemodialysis was significantly less in the 2cc/kg+FFP group (p<0.05).ConclusionPatients treated with the restrictive 2cc/kg+FFP formula received less fluid than the 3cc/kg and Parkland formula controls. With reduced fluids, patients had less mechanical ventilation, less dialysis, fewer tracheostomies, and better survival. AKI was minimal despite fluid restriction. Early experience suggests the new protocol is safe and feasible for further study.Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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