Early plasma transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage

Abstract

Background Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury (TBI). However, the choice of initial resuscitation fluid including the role of plasma is unclear for patients after isolated TBI. Methods We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated TBI. “Early plasma” was defined as transfusion of plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early plasma and in-hospital survival. After testing for interaction, sub-group analysis was performed based on pattern of brain injury on initial head CT: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage (MIH). Results Of the 633 isolated TBI patients included, 178 (28%) who received early plasma were more severely injured, coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early plasma versus no early plasma groups (78% versus 84%, p=0.08). After adjustment for covariates, early plasma was not associated with improved survival (odds ratio [OR] 1.18, 95% confidence interval [CI] 0.71 – 1.96). On subgroup analysis, multifocal intracranial hemorrhage (MIH) was the largest subgroup with 242 patients. Of these, 61 (25%) received plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early plasma was associated with improved survival (OR 3.34, 95% CI 1.20 – 9.35). Conclusion Although early plasma transfusion was not associated with improved in-hospital survival for all isolated TBI patients, early plasma was associated with increased in-hospital survival in those with MIH.

Every minute counts

“…17 A recent study has also demonstrated decreased mortality in traumatic brain injury (TBI) patients with multifocal hemorrhage that receive early administration of plasma. 18 …”

Outcomes after concomitant traumatic brain injury and hemorrhagic shock

“…Whereas brain injury has been shown to cause altered vascular compensation in response to HS, 31 questions remain about the relationship between coagulopathy and the size of brain lesions. 15,22,30,32,33 Ratio-guided resuscitation with fresh frozen plasma (FFP) may have beneficial effects for patients with TBI + HS, 15 including fewer inflammatory complications. 5,6,9 In experimental large animal studies, early administration of FFP reduced the size of brain lesions, decreased cerebral edema, and substantially attenuated the degree of neurological impairment.…”

“…5,6,9 However, very little is known about the clinical implications of DCR for patients with TBI and HS, especially considering the coagulopathy that often accompanies TBI. 1,10–15 Additionally, there is virtually no data on how DCR affects neurologic status and outcomes with concomitant TBI.…”

Dried Plasma

“…It also incurs neuroprotection by providing higher brain oxygenation and cerebral perfusion profiles [30]. In humans, a large retrospective cohort analysis showed that in the subgroup of patients with multifocal intracranial hemorrhage, early administration of plasma was associated with a survival benefit [31].…”