Research Reports - Early resuscitation with fresh frozen plasma for traumatic brain injury combined with hemorrhagic shock improves neurologic recovery

J Am Coll Surg. 2015 May;220(5):809-19

Halaweish I(1), Bambakidis T(1), He W(2), Linzel D(3), Chang Z(4), Srinivasan
A(5), Dekker SE(6), Liu B(1), Li Y(1), Alam HB(7)

BACKGROUND: We have shown that early administration of fresh frozen plasma (FFP)
reduces the size of brain lesions 6 hours after injury in a large animal model of
traumatic brain injury (TBI) and hemorrhagic shock (HS). To examine long-term
outcomes, we hypothesized that early treatment with FFP would result in faster
neurologic recovery and better long-term outcomes in a combined TBI and HS model.
STUDY DESIGN: Anesthetized Yorkshire swine underwent combined TBI and
volume-controlled hemorrhage (40% blood volume). After 2 hours of shock, animals
were randomized (n = 5/group) to normal saline (3× shed blood) or FFP (1× shed
blood) treatment. A neurologic severity score was assessed for 30 days. Magnetic
resonance imaging of the brain was performed at days 3, 10, and 24. Cognitive
function was tested by training animals to retrieve food from color-coded boxes.
RESULTS: Neurologic impairment was lower and speed of recovery was considerably
faster in the FFP-treated animals. There was a trend toward a smaller lesion size
in FFP-treated animal at days 3 and 10, but this did not reach statistical
significance. Both groups reached baseline performance on the cognitive testing;
however, FFP-treated animals were able to participate, on average, 8 days earlier
due to quicker recovery.
CONCLUSIONS: This is the first study to demonstrate the beneficial effects of FFP
treatment in a long-term survival model of combined TBI and HS. Our data show
that early treatment with FFP substantially attenuates the degree of neurologic
impairment, improves the rate of recovery, and preserves the cognitive functions.

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