Back to Search Results

Prehospital plasma is associated with survival principally in patients transferred from the scene of injury: A secondary analysis of the PAMPer trial

Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN. Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Department of Surgery, University of Louisville, Louisville, KY. Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. Department of Surgery, University of Texas Southwestern, Dallas, TX. Department of Pathology, University of Pittsburgh, Pittsburgh, PA. Department of Surgery, University of Tennessee Medical Center at Knoxville, Knoxville, TN. Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Electronic address: sperryjl@upmc.edu.

Surgery. 2022
Full text from:

Other resources

PICO Summary

Population

Severely injured trauma patients enrolled in the PAMPer trial (n= 501).

Intervention

Thawed plasma (n= 230).

Comparison

Standard pre-hospital air medical care (n= 271).

Outcome

For this secondary analysis of the PAMPer trial, the study population was composed of 390 (78%) patients with an air medical transfer origin from the scene of injury (SCENE) and 111 (22%) patients transferred from an outside referral emergency department (REF). Randomization to plasma or standard of care was equally distributed across each transfer origin group. The SCENE group had higher injury severity and were more likely intubated pre-hospital. The REF group had longer pre-hospital times and received greater pre-hospital crystalloid and blood products. Kaplan-Meier analysis revealed a significant 30-day survival benefit associated with pre-hospital plasma in the SCENE group with no difference found in the REF group. The Cox-regression verified after controlling for relevant confounders that pre-hospital plasma was independently associated with a 30-day survival in the SCENE group with no significant relationship found in the REF group.
Abstract
BACKGROUND We sought to characterize if prehospital transfer origin from the scene of injury (SCENE) or from a referral emergency department (REF) alters the survival benefit attributable to prehospital plasma resuscitation in patients at risk of hemorrhagic shock. METHODS We performed a secondary analysis of data from a recently completed prehospital plasma clinical trial. All of the enrolled patients from either the SCENE or REF groups were included. The demographics, injury characteristics, shock severity and resuscitation needs were compared. The primary outcome was a 30-day mortality. Kaplan-Meier analysis and Cox-hazard regression were used to characterize the independent survival benefits of prehospital plasma for transport origin groups. RESULTS Of the 501 enrolled patients, the REF group patients (n = 111) accounted for 22% with the remaining (n = 390) originating from the scene. The SCENE group patients had higher injury severity and were more likely intubated prehospital. The REF group patients had longer prehospital times and received greater prehospital crystalloid and blood products. Kaplan-Meier analysis revealed a significant 30-day survival benefit associated with prehospital plasma in the SCENE group (P < .01) with no difference found in the REF group patients (P = .36). The Cox-regression verified after controlling for relevant confounders that prehospital plasma was independently associated with a 30-day survival in the SCENE group patients (hazard ratio 0.59; 95% confidence interval 0.39-0.89; P = .01) with no significant relationship found in the REF group patients (hazard ratio 1.03, 95% confidence interval 0.4-3.0). CONCLUSION Important differences across the SCENE and REF cohorts exist that are essential to understand when planning prehospital studies. Prehospital plasma is associated with a survival benefit primarily in SCENE group patients. The results are exploratory but suggest transfer origin may be an important determinant of prehospital plasma benefit.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine