Early treatment with lyophilized plasma protects the brain in a large animal model of combined traumatic brain injury and hemorrhagic shock

Imam, Ayesha M.; Jin, Guang; Sillesen, Martin; Duggan, Michael; Jepsen, Cecilie H.; Hwabejire, John O.; Lu, Jennifer; Liu, Baoling; DeMoya, Marc; Velmahos, George C.; Alam, Hasan B.

doi:10.1097/ta.0b013e31829e2186

Cited by 30 publications

(23 citation statements)

References 37 publications

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“…This suggests that both neurologic and functional outcomes may be improved with the early use of plasma. These findings support recent large animal studies, (8,10), and highlight the need for further prospective research to ensure optimized neurologic outcomes in trauma patients with TBI.…”

Section: Discussionsupporting

confidence: 86%

Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury

Hernandez

Thiels

Aho

et al. 2017

Journal of Trauma and Acute Care Surgery

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Introduction Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. Methods We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBC) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow up. Results Of 76 patients meeting inclusion criteria 53% (n=40) received pre-hospital pRBC and 47% (n=36) received thawed plasma. Age, gender, injury severity (ISS) or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p>0.05). Patients that received thawed plasma had an improved neurologic outcome compared to those receiving pRBC (median GOSE 7 [7–8] vs 5.5 [3–7], p<0.001). Additionally, patients that received thawed plasma had improved functionality compared to pRBC (median DRS 2 [1–3.5] vs 9 [3–13], p<0.001). Calculated GOSE and DRS scores during follow up, median 6 [5–7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBC by both median GOSE (8 [7–8] vs 6 [6–7] p<0.001) and DRS (0 [0–1] vs 4 [2–8] p<0.001). Conclusion In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow up compared to pRBC alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. Level of evidence Level V – Retrospective Study Study type Retrospective single institution study

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Section: Discussionsupporting

confidence: 86%

Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury

Hernandez

Thiels

Aho

et al. 2017

Journal of Trauma and Acute Care Surgery

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show abstract

“…Plasma has been shown to have multiple neuroprotective effects in traumatic brain injury. In a swine model of polytrauma, hemorrhagic shock, and TBI, both lyophilized plasma (LP) and FFP were shown to decrease brain lesion size by 50% after 6 h of injury when compared to saline infusion; swelling was also 54% less in plasma-treated groups [74]. A follow-up study to evaluate the long-term effects of resuscitation with FFP vs. LP on neurological outcomes showed similar recovery of cognitive function in studied animals.…”

Section: Neuroprotective Effects Of Lyophilized Plasmamentioning

confidence: 88%

Dried Plasma

Zaza¹,

Kalkwarf²,

Holcomb³

2019

Damage Control Resuscitation

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“…In fact, our previous research has shown that early treatment with lyophilized plasma in a short-term model of TBI+HS offers the same neuroprotection as the conventional FFP (47). There is emerging evidence also that never-frozen, liquid plasma (LQP), which is approved for use for up to 26 days when stored at 1 to 6 °C, has an improved hemostatic profile (48) with decreased endothelial cell permeability compared to FFP (49).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 96%

Early Resuscitation with Fresh Frozen Plasma for Traumatic Brain Injury Combined with Hemorrhagic Shock Improves Neurologic Recovery

Halaweish

Bambakidis

et al. 2015

Journal of the American College of Surgeons

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Early treatment with lyophilized plasma protects the brain in a large animal model of combined traumatic brain injury and hemorrhagic shock

Abstract: In 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.

Cited by 30 publications

References 37 publications

Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury

Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury

Dried Plasma

Early Resuscitation with Fresh Frozen Plasma for Traumatic Brain Injury Combined with Hemorrhagic Shock Improves Neurologic Recovery

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