• Amir Shlaifer, Maya Siman-Tov, Irina Radomislensky, Kobi Peleg, Yoram Klein, Elon Glassberg, and Avraham Yitzhak.
• From the The Israel Defense Forces Medical Corps, Tel-Hashomer, Israel (S.A., G.E., Y.A.); Israel National Center for Trauma and Emergency Medicine (S.-T.M., R.I., P.K.), Gertner Institute for Epidemiology and Public Health Policy, Tel-Hashomer, Israel; Department of Disaster Management (P.K.), School of Public Health, Tel Aviv University, Tel Aviv, Israel; Division of Trauma and Emergency Surgery, Department of Surgery (K.Y.), Sheba Medical Center, Ramat-Gan, Israel; The Uniformed Services (G.E.), University of the Health Sciences, Bethesda, MD and Bar-Ilan University Faculty of Medicine (G.E.), Safed, Israel.
• J Trauma Acute Care Surg. 2019 Jan 1; 86 (1): 108-115.

BackgroundHemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma-induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty's remaining factors. The Israel Defense Force Medical Corps decided to use freeze-dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting. The aim of our study is to compare the differences of coagulation, perfusion measurements, resource utilization, and outcome between casualties receiving FDP to casualties who did not receive FDP in the prehospital setting.MethodsThis is a retrospective matched cohort study based on two groups of casualties (those treated with FDP vs. those without FDP treatment). The control group was compiled in three steps of precision for age, sex, mechanism of injury and maximum level of severity for each nine injured body regions. Data were collected from the IDF Trauma Registry and The National Israel Trauma Registry.ResultsThe study group comprised 48 casualties receiving FDP and 48 controls with no differences in demographic, evacuation time, and injury characteristics. The FDP group demonstrated a lower level of hemoglobin (12.7 gr/dzl) (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.10-8.80), lower level of international normalized ratio (1.1) (OR, 3.09; 95% CI, 1.04-9.14), and lower level of platelets (230 × 109/L) (OR, 3.06; 95% CI, 1.16-8.06). No other differences were found between the two groups.ConclusionThe use of FDP in the prehospital setting has logistic benefits and a positive effect on coagulation profile, with no other significant effects. Future studies need to be performed on larger groups to verify trends or nullify our hypotheses.Level Of EvidenceTherapeutic, level IV.

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