Severe trauma patients are at risk for hemorrhagic shock and death, and timely resuscitation is crucial for survival. The Prehospital Air Medical Plasma (PAMPer) trial demonstrated that pre-hospital plasma transfusions reduce mortality by 10% compared to standard care for these patients. Secondary analysis of 407 severe trauma patients from this same trial suggests that prehospital blood products reduce 30-day mortality compared to crystalloid resuscitation. One hundred thirty-nine (34%) patients received only crystalloid resuscitation, 83 (20%) received RBCs, 147 (36%) received plasma, and 38 (10%) received both RBCs and plasma. Patients who received prehospital blood products had a significantly reduced risk of 30-day mortality compared to those who only received crystalloid. Patients in the RBC and plasma group had the lowest risk of 30-day mortality (adjusted hazard ratio [HR] = 0.38; 95% CI, 0.26-0.55; P<0.001), followed by plasma (HR=0.57) and then RBC (HR=0.68) as compared to patients in the crystalloid group. These data suggest that severe trauma patients at risk for hemorrhagic shock should receive pr-ehospital blood products instead of crystalloid resuscitation. Randomized controlled trials designed to investigate the use of pre-hospital whole blood for these patients compared to other blood products are currently ongoing.
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