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Pre‐hospital freeze‐dried plasma for critical bleeding after trauma: A pilot randomized controlled trial.
- Source :
- Academic Emergency Medicine; Oct2023, Vol. 30 Issue 10, p1013-1019, 7p
- Publication Year :
- 2023
-
Abstract
- Objectives: Transfusion of a high ratio of plasma to packed red blood cells (PRBCs), to treat or prevent acute traumatic coagulopathy, has been associated with survival after major trauma. However, the effect of prehospital plasma on patient outcomes has been inconsistent. The aim of this pilot trial was to assess the feasibility of transfusing freeze‐dried plasma with red blood cells (RBCs) using a randomized controlled design in an Australian aeromedical prehospital setting. Methods: Patients attended by helicopter emergency medical service (HEMS) paramedics with suspected critical bleeding after trauma managed with prehospital RBCs were randomized to receive 2 units of freeze‐dried plasma (Lyoplas N‐w) or standard care (no plasma). The primary outcome was the proportion of eligible patients enrolled and provided the intervention. Secondary outcomes included preliminary data on effectiveness, including mortality censored at 24 h and at hospital discharge, and adverse events. Results: During the study period of June 1 to October 31, 2022, there were 25 eligible patients, of whom 20 (80%) were enrolled in the trial and 19 (76%) received the allocated intervention. Median time from randomization to hospital arrival was 92.5 min (IQR 68–101.5 min). Mortality may have been lower in the freeze‐dried plasma group at 24 h (RR 0.24, 95% CI 0.03–1.73) and at hospital discharge (RR 0.73, 95% CI 0.24–2.27). No serious adverse events related to the trial interventions were reported. Conclusions: This first reported experience of freeze‐dried plasma use in Australia suggests prehospital administration is feasible. Given longer prehospital times typically associated with HEMS attendance, there is potential clinical benefit from this intervention and rationale for a definitive trial. [ABSTRACT FROM AUTHOR]
- Subjects :
- HEMORRHAGE treatment
INJURY complications
PILOT projects
AIRPLANE ambulances
CONFIDENCE intervals
BLOOD plasma
BLOOD collection
TREATMENT effectiveness
RANDOMIZED controlled trials
FREEZE-drying
RESEARCH funding
DESCRIPTIVE statistics
CHI-squared test
EMERGENCY medical services
RED blood cell transfusion
DATA analysis software
ODDS ratio
EMERGENCY medicine
EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 10696563
- Volume :
- 30
- Issue :
- 10
- Database :
- Complementary Index
- Journal :
- Academic Emergency Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 172959625
- Full Text :
- https://doi.org/10.1111/acem.14745