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.

Source

JAMA