Since the US Food and Drug Administration may soon approve freeze-dried or lyophilized plasma, several trials have recently investigated the efficacy of prehospital plasma transfusions in trauma patients. The Prehospital Air Medical Plasma (PAMPer) trial published in The New England Journal of Medicine in July found that trauma patients who received plasma during air transport (median transport time ~40 minutes) to the hospital had lower mortality at 24 hours and 30 days than those trauma patients who received standard care. However, the Control of Major Bleeding After Trauma (COMBAT) trial published in The Lancet found that plasma transfusion was not associated with lower mortality. In this pragmatic, randomized single-hospital trial, 65 trauma patients received plasma transfusions during ground transport while 60 received saline. Mortality at 28 days was similar in both groups—15% in the plasma group compared to 10% in the standard care group (p=0.37). Both groups in the COMBAT trial had similar baseline characteristics and transport times (19 minutes [IQR 16-23] for the plasma group and 16 min [IQR 14-22] for the control group). The differential results from the PAMPer and COMBAT study could be due to a number of factors including differences in transfer time and severity of injury. Further research on the efficacy of prehospital plasma transfusion is clearly warranted.
References:
- Moore HB, Moore EE, Chapman MP, McVaney K, et al. Plasma-first resuscitation to treat heamorrhagic shock during emergency ground transportation in an urban area: a randomized trial. The Lancet 2018; 392; 283-291.
- Naumann DN, Doughty H, Cotton BA. No gains with plasma-first resuscitation in urban settings? The Lancet 2018; 392; 255-256.
- 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.
