Nearly 50,000 Americans die from severe injuries each year, mainly from severe hemorrhage within two hours after the injury. Time-sensitive care is critical to the survival of these patients. The Prehospital Air Medical Plasma (PAMPer) trial has been investigating the efficacy and safety of pre-hospital plasma transfusions compared to standard care in trauma patients at risk for hemorrhagic shock. In this pragmatic, randomized, controlled trial, 230 trauma patients were transfused with two units of fresh-frozen plasma before any other resuscitation fluids were given and 271 trauma patients received standard care (crystalloid solution alone or in combination with red cells). The trauma patients who received plasma were more likely to survive—mortality at 30 days was 23.2% in the plasma group compared to 33.0% in the standard care group (P=0.03). Moreover, the transfusion of plasma did not delay the patient’s arrival to the trauma center, and patients in both groups had similar incidences of multiorgan failure, acute lung injury-acute respiratory distress syndrome, infections, and adverse transfusion events. Further research is needed in order to determine the ideal blood product that should be transfused in trauma patients—fresh-frozen plasma, never-frozen liquid plasma, freeze dried plasma, or refrigerated whole blood. In the meantime, trauma centers should consider using plasma for trauma patients at risk for hemorrhagic shock.
References:
- Sperry JL, Guyette FX, Brown JB, Yazer MH, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. The New England Journal of Medicine 2018; 379(4); 315-326.
- Cannon JW. Prehospital damage-control resuscitation. The New England Journal of Medicine 2018; 379(4); 387-388.
