1. Prehospital plasma transfusion is associated with increased survival in the setting of hemorrhagic shock, particularly with longer transport times
Evidence Rating Level: 1 (Excellent)
It has been well established that the early transfusion of blood products in the setting of hemorrhagic shock reduces associated morbidity and mortality. Only recently, however, have a number of trauma systems begun to incorporate red blood cell, plasma or whole blood transfusion in the pre-hospital setting. The PAMPer and COMBAT clinical trials were two prospective randomized studies of prehospital administration of plasma, the results of which were contradictory. In the current study, the authors conducted a post-analysis using combined data from both studies (n=626) to determine whether prehospital plasma administration is more beneficial when patient transport times are longer. As part of both original trials, patients with trauma and hemorrhagic shock were randomly assigned to receive either standard care or 2 units of thawed plasma in the prehospital environment. Of the 626 patients included in the study, 74.6% were male and the median age was 42 years (IQR 27 to 57 years). Based on an adjusted survival analysis, researchers found a significant overall survival benefit with prehospital plasma administration (HR 0.65, 95% CI 0.47 to 0.90, p=0.01). Importantly, researchers noted that survival was influenced by pre-hospital transport time in patients who received standard care, where the rate and likelihood of mortality were increased 2-fold with transport times in excess of 20 minutes (HR 2.12, 95% CI 1.05 to 4.30, p=0.04). This was not observed in patients who received prehospital plasma (HR 0.78, 95% CI 0.40 to 1.51, p=0.46). Furthermore, although there was no significant difference in survival for patients with short transport times (<20 minutes), survival was improved in the plasma group when transport times were longer (HR 0.56, 95% CI 0.40 to 0.80, p=0.001). This study therefore shows that prehospital plasma transfusion is associated with increased survival in the setting of hemorrhagic shock, particularly with longer transport times.
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