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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, March 17, 2023

Prehospital plasma in Trauma

52 in 52 – #29 emDOCs - March 16TH, 2023 - By Christiaan van Nispen and Brannon Inman
Reviewed by: Alex Koyfman; Brit Long
Clinical question: In patients at risk for hemorrhagic shock, is there a mortality benefit to pre-hospital transfusion of plasma as the initial resuscitation fluid compared to the standard of care?
Take aways:
  • Positive trial: pre-hospital plasma appears superior to standard of care alone.
  • Intervention group was less likely to be administered prehospital pRBCs (26.1% vs. 42.1%) and received lower median crystalloid volume (500mL vs. 900mL) yet had better 30-day mortality outcomes.
  • Effect was larger in the patients transported from scene compared to patients transported from a referring ED, suggesting that earlier plasma transfusion might be better, though more research is necessary for validation.
  • Though statistically significant, it is unlikely that the 0.1 difference in initial prothrombin time is physiologically or clinically meaningful enough to account for the apparent mortality benefit.
  • The study is appropriately powered and has limited loss to follow-up.
My take:
  • In patients with pre-hospital signs of hemorrhagic shock, pre-hospital plasma transfusion in conjunction with pRBCs and/or crystalloid appears superior to pRBCs and/or crystalloid alone, which tracks with other recent data demonstrating that balanced transfusion and the avoidance of crystalloid are best practices.
  • More research is needed to validate the results of this trial, with better standardized local protocols regarding the transfusion of other blood products and crystalloid.