• Ayesha M Imam, Guang Jin, Martin Sillesen, Michael Duggan, Cecilie H Jepsen, John O Hwabejire, Jennifer Lu, Baoling Liu, Marc A DeMoya, George C Velmahos, and Hasan B Alam.
• From the Division of Trauma, Emergency Surgery and Surgical Critical Care, (A.M.I., G.J., M.S., M.D., C.H.J., J.O.H., J.L., M.A.D., G.C.V., H.B.A.), Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; and Department of Surgery (G.J., B.L., H.B.A.), University of Michigan Hospital, Ann Arbor, Michigan.
• J Trauma Acute Care Surg. 2013 Dec 1;75(6):976-83.

BackgroundCombination of traumatic brain injury (TBI) and hemorrhagic shock (HS) can result in significant morbidity and mortality. We have previously shown that early administration of fresh frozen plasma (FFP) in a large animal model of TBI and HS reduces the size of the brain lesion as well as the associated edema. However, FFP is a perishable product that is not well suited for use in the austere prehospital settings. In this study, we tested whether a shelf-stable, low-volume, lyophilized plasma (LSP) product was as effective as FFP.MethodsYorkshire swine (42-50 kg) were instrumented to measure hemodynamic parameters, intracranial pressure, and brain tissue oxygenation. A prototype, computerized, cortical impact device was used to create TBI through a 20-mm craniotomy: 15-mm cylindrical tip impactor at 4 m/s velocity, 100-millisecond dwell time, and 12-mm penetration depth. Volume-controlled hemorrhage was induced (40-45% total blood volume) concurrent with the TBI. After 2 hours of shock, animals were treated with (1) normal saline (NS, n = 5), (2) FFP (n = 5), and (3) LSP (n = 5). The volume of FFP and LSP matched the shed blood volume, whereas NS was 3 times the volume. Six hours after resuscitation, brains were sectioned and stained with TTC (2, 3, 5-Triphenyltetrazolium chloride), and lesion size (mm) and swelling (percent change in volume compared with the contralateral, uninjured side) were measured.ResultsThis protocol resulted in a highly reproducible brain injury, with clinically relevant changes in blood pressure, cardiac output, tissue hypoperfusion, intracranial pressure, and brain tissue oxygenation. Compared with NS, treatment with LSP significantly (p < 0.05) decreased brain lesion size and swelling (51% and 54%, respectively).ConclusionIn a clinically realistic combined TBI + HS model, early administration of plasma products decreases brain lesion size and edema. LSP is as effective as FFP, while offering many logistic advantages.

20 keywords...

hide…