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Tucker H, Davenport R, Green L. The Role of Plasma Transfusion in Pre-Hospital Haemostatic Resuscitation. Transfus Med Rev. 2021;35(4):91-95doi: 10.1016/j.tmrv.2021.08.004.
Tucker, H., Davenport, R., & Green, L. (2021). The Role of Plasma Transfusion in Pre-Hospital Haemostatic Resuscitation. Transfusion medicine reviews, 35(4), 91-95. https://doi.org/10.1016/j.tmrv.2021.08.004
Tucker, Harriet, et al. "The Role of Plasma Transfusion in Pre-Hospital Haemostatic Resuscitation." Transfusion medicine reviews vol. 35,4 (2021): 91-95. doi: https://doi.org/10.1016/j.tmrv.2021.08.004
Tucker H, Davenport R, Green L. The Role of Plasma Transfusion in Pre-Hospital Haemostatic Resuscitation. Transfus Med Rev. 2021 Oct;35(4):91-95. doi: 10.1016/j.tmrv.2021.08.004. Epub 2021 Sep 05. PMID: 34593289.
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Transfus Med Rev. 2021 Oct;35(4):91-95. doi: 10.1016/j.tmrv.2021.08.004. Epub 2021 Sep 05.

The Role of Plasma Transfusion in Pre-Hospital Haemostatic Resuscitation.

Transfusion medicine reviews

Harriet Tucker, Ross Davenport, Laura Green

Affiliations

  1. Blizard Institute, Queen Mary University of London, London, UK.
  2. Blizard Institute, Queen Mary University of London, London, UK; Departmen of Trauma, Barts Health NHS Trust, London, UK.
  3. Blizard Institute, Queen Mary University of London, London, UK; Departmen of Trauma, Barts Health NHS Trust, London, UK; Blood Component division, NHS Blood and Transplant, London, UK. Electronic address: [email protected].

PMID: 34593289 DOI: 10.1016/j.tmrv.2021.08.004

Abstract

Traumatic haemorrhage remains a major cause of preventable death and early haemostatic resuscitation is now a mainstay of treatment internationally. Recently, 2 randomized control trials (RCTs) - PAMPer (Prehospital Air Medical Plasma) and COMBAT (Control of Major Bleeding After Trauma), evaluating the effect of pre-hospital use of plasma on mortality provided conflicting results, raising important questions on the role of plasma resuscitation in pre-hospital environment. Both PAMPer (n = 501 patients) and COMBAT (n = 144 patients) trials were pragmatic RCTs that evaluated the effect of pre-hospital plasma transfusion (two units) versus standard of care on 28/30 days mortality in trauma patients who presented with clinical signs of haemorrhagic shock (defined as hypotension or tachycardia). The PAMPer trial showed that plasma transfusion reduced 30-day mortality compared with standard of care (23% vs 33%, 95% confidence interval -18.6; -1.0%; P = 0.03), while COMBAT trial showed no difference in 28-day survival. The post-hoc analyses of the 2 trials have suggested that the benefit of pre-hospital plasma transfusion may be greater for patients who are coagulopathic, have blunt injury and have a transport time from the scene of injury to the hospital of >20 minutes. In this review we evaluate strengths and limitations of the two trials and their differences and similarities, which may explain the conflicting results, as well as provide directions for future trials to better define the target population that would most benefit from pre-hospital plasma resuscitation. Further, considering the logistical challenges of carrying any blood components on an aircraft, cost/safety of plasma, and the scarcity of universal blood group donors, there is a need for a health economic evaluation of pre-hospital plasma transfusion in trauma patients, prior to this intervention becoming universal.

Copyright © 2021 Elsevier Inc. All rights reserved.

Keywords: Coagulopathy of trauma; Endotheliopathy; Plasma; Pre-hospital; Transfusion

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