Association of Prehospital Plasma with Survival in Patients With Traumatic Brain Injury : A Secondary Analysis of the PAMPer Cluster Randomized Clinical Trial
- Several studies have indicated that early treatment with plasma may benefit trauma patients.
- Early administration may lessen endothelial damage and inflammation, reducing the effects of shock and secondary brain injury. Plasma may also limit excessive crystalloid use and its adverse effects.
- Sub-analysis of traumatic brain injury (TBI) patients enrolled in the PAMPer (Prehospital Air Medical Plasma) trial
- Regression model developed evaluating TBI patients
- PAMPer was a pragmatic, phase 3, multicentral, cluster-randomized trial.
- Subjects were injured patients at risk for hemorrhagic shock during air transport to a trauma center
- Six US sites with nine level 1 trauma centers
- Patients randomized to receive standard fluid resuscitation or two units of thawed plasma
- 501 patients analyzed; 203 received plasma
- 166 TBI patients: 43 years old, 75% men, all sustained blunt trauma
- Median Injury Severity Score (ISS) 29, and over half had a subdural hematoma or hemorrhage
- Patients receiving prehospital plasma received less crystalloid fluid, vasopressors, and packed red cells in first 24 hours of hospitalization.
- Patients receiving prehospital plasma had lower unadjusted 24-hour and 30-day mortality (16% vs 35.9% and 35.1% vs 55.4%).
- This association remained significant after accounting for multiple confounding variables.
- The survival benefit did not extend to patients who were transferred from an outside hospital before receiving plasma.
- Despite these benefits, patients receiving plasma had a greater incidence of multiple organ failure, longer intensive care unit stays, and longer hospital stays.