• Vincent P Anto, Frank X Guyette, Joshua Brown, Brian Daley, Richard Miller, Brian Harbrecht, Jeffrey Claridge, Herb Phelan, Matthew Neal, Raquel Forsythe, Brian Zuckerbraun, Jason Sperry, and And The PAMPer study group.
• From the Department of Surgery (V.P.A., J.B., M.N., R.F., B.Z., J.S.), Department of Emergency Medicine (F.X.G.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery (B.D.), University of Tennessee Health Science Center, Knoxville; Department of Surgery (R.M.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery, University of Louisville, Louisville (B.H.), Kentucky; Department of Surgery, MetroHealth Medical Center (J.C.), Case Western Reserve University, Cleveland, Ohio; and Department of Surgery (H.P.), University of Texas Southwestern, Parkland Memorial Hospital, Dallas, Texas.
• J Trauma Acute Care Surg. 2020 Jan 1; 88 (1): 141-147.

BackgroundRecent randomized clinical trial evidence demonstrated a survival benefit with the use of prehospital plasma in patients at risk of hemorrhagic shock. We sought to characterize the survival benefit associated with prehospital plasma relative to the blood transfusion volume over the initial 24 hours. We hypothesized that the beneficial effects of prehospital plasma would be most robust in those with higher severity of hemorrhage.MethodsWe performed a prespecified secondary analysis using data derived from a prospective randomized prehospital plasma trial. Blood component transfusion volumes were recorded over the initial 24 hours. Massive transfusion (MT) was defined a priori as receiving ≥10 units of red cells in 24 hours. We characterized the 30-day survival benefit of prehospital plasma and the need for MT and overall 24-hour red cell transfusion volume utilizing Kaplan-Meier survival analysis and Cox proportional hazard regression.ResultsThere were 501 patients included in this analysis with 230 randomized to prehospital plasma with 104 patients requiring MT. Mortality in patients who received MT were higher compared with those that did not (MT vs. NO-MT, 42% vs. 26%, p = 0.001). Kaplan-Meier survival curves demonstrated early separation in the NO-MT subgroup (log rank p = 0.008) with no survival benefit found in the MT group (log rank p = 0.949). Cox regression analysis verified these findings. When 24-hour red cell transfusion was divided into quartiles, there was a significant independent association with 30-day survival in patients who received 4 to 7 units (hazard ratio, 0.33, 95% confidence interval, 0.14-0.80, p = 0.013).ConclusionThe survival benefits of prehospital plasma was demonstrated only in patients with red cell requirements below the transfusion level of MT. Patients who received 4 to 7 units of red cells demonstrated the most robust independent survival benefit attributable to prehospital plasma transfusion. Prehospital plasma may be most beneficial in those patients with moderate transfusion requirements and mortality risk.Level Of EvidenceTherapeutic, Level I.

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