Research Reports - Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury

J Trauma Acute Care Surg. 2017 May 22. doi: 10.1097/TA.0000000000001581. [Epub
ahead of print]

Hernandez MC(1), Thiels CA, Aho JM, Habermann EB, Zielinski MD, Stubbs JA,
Jenkins DH, Zietlow SP.

INTRODUCTION: Trauma related hypotension and coagulopathy worsen secondary brain
injury in patients with traumatic brain injuries (TBI). Early damage control
resuscitation with blood products may mitigate hypotension and coagulopathy.
Preliminary data suggest resuscitation with plasma in large animals improve
neurologic function after TBI; however, data in humans are lacking.
METHODS: We retrospectively identified all poly-trauma patients age >15 years
with head injuries undergoing prehospital resuscitation with blood products at a
single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were
prehospital resuscitation with either packed red blood cells (pRBC) or thawed
plasma as sole colloid resuscitation. Patients who died in hospital and those
using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score
Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow
up.
RESULTS: Of 76 patients meeting inclusion criteria 53% (n=40) received
pre-hospital pRBC and 47% (n=36) received thawed plasma. Age, gender, injury
severity (ISS) or TBI severity, arrival laboratory values, and number of
prehospital units were similar (all p>0.05). Patients that received thawed plasma
had an improved neurologic outcome compared to those receiving pRBC (median GOSE
7 [7-8] vs 5.5 [3-7], p<0.001). Additionally, patients that received thawed
plasma had improved functionality compared to pRBC (median DRS 2 [1-3.5] vs 9
[3-13], p<0.001). Calculated GOSE and DRS scores during follow up, median 6 [5-7]
months, demonstrated increased function in those resuscitated with thawed plasma
compared to pRBC by both median GOSE (8 [7-8] vs 6 [6-7] p<0.001) and DRS (0
[0-1] vs 4 [2-8] p<0.001).
CONCLUSION: In critically injured trauma patients with TBI, early resuscitation
with thawed plasma is associated with improved neurologic and functional outcomes
at discharge and during follow up compared to pRBC alone. These preliminary data
support the further investigation and use of plasma in the resuscitation of
critically injured TBI patients.
LEVEL OF EVIDENCE: Level V - Retrospective Study STUDY TYPE: Retrospective single
institution study. 

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