The evolving role of lyophilized plasma in remote damage control resuscitation in the French Armed Forces Health Service

Abstract

Freeze-dried plasma was developed by the US Army for the resuscitation of combat casualties during World War II. The French Military Blood Institute began producing French lyophilized plasma (FLYP) in 1949, in accordance with French blood product guidelines. Since 2010, a photochemical pathogen inactivation process has been implemented to reduce the remaining transfusion-related infectious risk. All quality controls for this procedure verify that the hemostatic properties of FLYP are conserved. FLYP is compatible with all blood types, can be stored at room temperature for 2 years, and its reconstitution requires less than 6 minutes. As a result, FLYP allows quick delivery of all the coagulation proteins and the application of a 1:1 ratio of FLYP and red blood cells in the context of a massive transfusion. Hemovigilance data collected in France since 1994 have included FLYP. Results indicate no reporting of infection related to the use of FLYP. Clinical monitoring with a focus on hemostasis was implemented in 2002 and expanded in 2010. The data, obtained from overseas operations, confirmed the indications, the safety and the clinical efficacy of FLYP. Further research is needed to determine specific indications for FLYP in the therapeutic management of civilian patients with severe hemorrhage.

Early Resuscitation with Fresh Frozen Plasma for Traumatic Brain Injury Combined with Hemorrhagic Shock Improves Neurologic Recovery

“…The fact that FFP can be lyophilized into a low weight, shelf-stable formulation has opened up the possibility of its use in the pre-hospital setting in the near future (23,46). In fact, our previous research has shown that early treatment with lyophilized plasma in a short-term model of TBI+HS offers the same neuroprotection as the conventional FFP (47).…”

Advances in damage control resuscitation and surgery: implications on the organization of future military field forces

“…After more than 2 years of storage at ambient temperature, the fibrinogen and clotting factor levels of FDSP are equivalent to those of fresh frozen plasma. [36][37][38] There is now increasing international interest in using freeze-dried plasma for remote DCR, 39,40 despite regulatory challenges. Fibrinogen concentrate is another possible solution.…”

Massive Transfusion Protocols

“…Finally, lyophilized plasma is being developed that can be reconstituted quickly at the time and site of use and is already available and used in select European countries [ 74 ].…”