Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial

Abstract

Background The Pragmatic Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of 2 different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets and red blood cells within 10 minutes of request. Study Design and Methods At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons (ACS) guidelines. Results Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma receiving unit within 10 minutes, and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared. Conclusion Delivering UD plasma to massively hemorrhaging patients was accomplished consistently, rapidly and without excessive wastage in high-volume trauma centers. The ACS Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.

Every minute counts

“…Prior to starting the study, and as part of site training and verification, each site was evaluated for the ability of its blood bank to randomize, prepare, and deliver the first MTP cooler to the bedside within ten minutes, as well as to prepare and deliver subsequent coolers on-demand. 11 As such, time of arrival, time to MTP activation and time to arrival of initial and each subsequent cooler were collected as time points of interest. The content of each MTP cooler was identical between centers, varying only by randomization group ( i.e.…”

Fibrinogen in traumatic haemorrhage: A narrative review

“…A number of studies have reported that in patients receiving higher ratios there is an increase in the amount of plasma transfused and an increased incidence of transfusion-related adverse events without a survival benefit, however, these concerns were not confirmed in the PROPPR trial (49) (50) (51). Time to delivery of product replacement in PROPPR was rapidly achieved without significant wastage but this is dependent on having thawed product available 24 hours a day in either the trauma unit or blood bank (52). The impressive delivery of blood component therapy as described in the PROPPR trial may be difficult to translate into routine clinical practise (53).…”

14-Day thawed plasma retains clot enhancing properties and inhibits tPA-induced fibrinolysis

“…The transition of large trauma centers to thawed plasma has led to a near 50% decrease in time to plasma transfusion 23,24 resulting in an independent predictor of decreased mortality. 23 The trade-off with the increasing use of thawed plasma is the 2.2% wastage rate, most of which is limited AB donor plasma.…”