Prehospital Lyophilized Plasma Transfusion for Trauma-Induced Coagulopathy in Patients at Risk for Hemorrhagic Shock

Abstract

Key Points Question Does prehospital transfusion of lyophilized plasma result in a lower incidence of trauma-induced coagulopathy at hospital admission compared with standard care with normal saline infusion in patients at risk for hemorrhagic shock after trauma? Findings This multicenter randomized clinical trial included 150 patients with trauma who were treated in a prehospital setting. Median international normalized ratio at hospital admission, massive transfusion rate, 30-day survival, and adverse events did not significantly differ between lyophilized plasma transfusion and standard care. Meaning These findings suggest that prehospital lyophilized plasma transfusion is a feasible and safe procedure for patients who are at risk for hemorrhagic shock, although there is a lack of evidence regarding its ability to prevent trauma-induced coagulopathy.

Use of prehospital transfusion by French emergency medical services: A national survey

“…This point, also reported in a 2020 European survey, 15 highlights the lack of scientific evidence of the benefit of PHT in the civilian setting. Recent PrehoPLYO 24 and RePHILL 37 trials did not show survival improvement when using PHT in trauma patients. However, medical pathologies are the first causes of PHT according to our results, which is confirmed by the few European practice studies available.…”

“…23 In our study, 34% of the SMURs had access to plasma, including 7% for which lyophilized plasma was available as part of the PrehoPLYO study. 24 The publication of national recommendations 7 after our survey will require further evaluation of the use of FLyP in the French prehospital setting. As a comparison, a recent survey among UK Air Ambulances showed that 37% carried RBCs and freeze-dried plasma, and 32% carried RBCs and thawed plasma.…”

Past meets present: Reviving 80‐year‐old Canadian dried serum from World War II and its significance in advancing modern freeze‐dried plasma for prehospital management of haemorrhage

“…11 Haemorrhage accounts for approximately 40% of trauma-related deaths, with approximately 50% occurring in civilian and 90% in combat settings before the patient reaches definitive care. 22,23 Currently there are three controlled, randomized clinical studies, namely PREHO-PLYO, 24 RePHILL 25 and a pilot trial by Mitra et al, 26 that examine the efficacy of FDP in trauma. These studies do not show added benefit of prehospital FDP in trauma patients.…”

“…PREHO-PLYO measured laboratory international normalized ratio as the primary outcome and was underpowered to measure mortality differences between arms as mortality was a secondary outcome. 24,28 While RePHILL demonstrated 25% reduction in 3-h mortality (risk ratio 0.75, p = 0.17) in patients that received FDP, it examined episode mortality, which included both pre-and in-hospital mortality. 25,28 Episode mortality may represent points that are too distant to effectively evaluate prehospital FDP.…”

Current advances in 2022: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee

“…Jost et al performed a randomized trial of prehospital lyophilized plasma versus crystalloid in 150 trauma patients. 30 The primary outcome was the international normalized ratio upon hospital arrival. 31 Lyophilized plasma was not different from crystalloid for any outcome, including posthoc analyses for hemorrhagic death or 6-h mortality.…”