Prehospital fresh frozen plasma: Universal life saver or treatment in search of a target population?

Makris, Michael; Iorio, Alfonso

doi:10.1002/rth2.12172

Cited by 12 publications

(10 citation statements)

References 7 publications

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“…A conventional approach suggests that administration of coagulation factors and fibrinogen in the form of plasma close to the time of injury could prevent or limit development of TIC. This may not be the case, as the increase in factor levels in both COMBAT and PAMPeR was estimated to be 7% at best, 30 which may also reflect insufficient plasma resuscitation. Certainly, the data are insufficient to examine the levels of coagulation factor depletion most likely to respond to plasma infusion by preserving coagulation function.…”

Section: Pht Conmentioning

confidence: 99%

“…Additionally, the measured levels of coagulation factors and fibrinogen in COMBAT on arrival to the hospital were normal both in control and intervention groups. 27 These data (though incomplete at best) suggest that if PHT plasma does work by preventing TIC, the underlying mechanism may not be coagulation factor replenishment but (unmeasured) effects on the endothelial glycocalyx, vascular permeability, and inflammation, 30,31 which require further study.…”

Section: Pht Conmentioning

confidence: 99%

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Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Dudaryk

Heim

Ruetzler

et al. 2022

Anesthesia &Amp; Analgesia

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Exsanguination is the leading cause of death in severely injured patients; nevertheless, prehospital blood transfusion (PHT) remains a controversial topic. Here, we review the pros and cons of PHT, which is now routine in treatment of military trauma patients in the civilian setting. While PHT may improve survival in those who suffer blunt injury or require prolonged transport from the site of injury, PHT for civilian trauma generally is not supported by high-quality evidence. This article was originally presented as a pro-con debate at the 2020 meeting of the European

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Section: Pht Conmentioning

confidence: 99%

Section: Pht Conmentioning

confidence: 99%

Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Dudaryk

Heim

Ruetzler

et al. 2022

Anesthesia &Amp; Analgesia

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show abstract

“…In contrast, Moore et al reported that 2 U of thawed plasma prior to other fluids during ground ambulance transport in a single-center clinical trial (with short transport times and immediate in-hospital access to blood components) did not improve survival. Recent commentaries have addressed the potential implications of these studies …”

Section: Introductionmentioning

confidence: 99%

Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes

et al. 2020

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IMPORTANCE Both military and civilian clinical practice guidelines include early plasma transfusion to achieve a plasma to red cell ratio approaching 1:1 to 1:2. However, it was not known how early plasma should be given for optimal benefit. Two recent randomized clinical trials were published, with apparently contradictory results. The Prehospital Air Medical Plasma (PAMPer) clinical trial showed a nearly 30% reduction in mortality with plasma transfusion in the prehospital environment, while the Control of Major Bleeding After Trauma (COMBAT) clinical trial showed no survival improvement.OBJECTIVE To facilitate a post hoc combined analysis of the COMBAT and PAMPer trials to examine questions that could not be answered by either clinical trial alone. We hypothesized that prehospital transport time influenced the effects of prehospital plasma on 28-day mortality.DESIGN, SETTING, AND PARTICIPANTS A total of 626 patients in the 2 clinical trials were included. Patients with trauma and hemorrhagic shock were randomly assigned to receive either standard care or 2 U of thawed plasma followed by standard care in the prehospital environment. Data analysis was performed between September 2018 and January 2019.INTERVENTIONS Prehospital transfusion of 2 U of plasma compared with crystalloid-based resuscitation. MAIN OUTCOMES AND MEASURESThe main outcome was 28-day mortality. RESULTSIn this post hoc analysis of 626 patients (467 men [74.6%] and 159 women [25.4%]; median [interquartile range] age, 42 [27-57] years) who had trauma with hemorrhagic shock, a Cox regression analysis showed a significant overall survival benefit for plasma (hazard ratio [HR], 0.65; 95% CI, 0.47-0.90; P = .01) after adjustment for injury severity, age, and clinical trial cohort (COMBAT or PAMPer). A significant association with prehospital transport time was detected (from arrival on scene to arrival at the trauma center). Increased mortality was observed in patients in the standard care group when prehospital transport was longer than 20 minutes (HR, 2.12; 95% CI, 1.05-4.30; P = .04), while increased mortality was not observed in patients in the prehospital plasma group (HR, 0.78; 95% CI, 0.40-1.51; P = .46). No serious adverse events were associated with prehospital plasma transfusion.CONCLUSIONS AND RELEVANCE These data suggest that prehospital plasma is associated with a survival benefit when transport times are longer than 20 minutes and that the benefit-risk ratio is favorable for use of prehospital plasma.

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“…16 The Control of Major Bleeding After Trauma (COMBAT) RCT individually randomly assigned 125 trauma patients in hemorrhagic shock to 2 units of thawed AB plasma, or saline, during ground transportation to a single urban trauma center, and reported no significant differences in 28-day mortality; the trial enrolled 144 of a planned 150 patients before it was halted for futility. 17 Although controversies abound in the interpretation of the two trials, 18,19 taken together 20 they have strengthened the possibility that prehospital plasma transfusion could save lives and have hastened efforts to develop new and rugged FDP products for use in remote or austere environments.…”

mentioning

confidence: 99%

Rejuvenated and safe: Freeze‐dried plasma for the 21st century

Sheffield

Devine

2022

Transfusion

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Prehospital fresh frozen plasma: Universal life saver or treatment in search of a target population?

Cited by 12 publications

References 7 publications

Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes

Rejuvenated and safe: Freeze‐dried plasma for the 21st century

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