September 27, 2018

Plasma study proves increased survival rate of critically injured patients

 A Vanderbilt University Medical Center study has found that giving fresh, frozen plasma to critically injured patients in hemorrhagic shock during medical helicopter transport decreased their need for blood transfusions and improved survival.  

 VUMC enrolled 97 patients in this four-year study; 42 received plasma, and 55 received standard care. After 30 days, 69 percent of those 42 patients who received plasma survived, compared to 63 percent of patients who received standard care, which includes giving red blood cell transfusions.

From July 2014 through September 2017, two LifeFlight helicopters, based in Clarksville and Murfreesboro, administered plasma or standard care, for one-month intervals. During the plasma interval, as soon as the patient was deemed eligible for trial, the medical teams began administering two units of plasma to the patient. Once the units were completed, the medical team reverted to standard care.  

“The most important part was plasma lowered the amount of blood transfusions that a patient actually got throughout their hospital stay. It improved their clotting, which makes sense if you give fresh frozen plasma instead of crystalloids (saline), and it improved survival,” said co-author, Richard Miller, MD, chief of the Division of Trauma and Surgical Critical Care.  

During the Prehospital Air Medical Plasma (PAMPer) trial, which is a national study that included nine trauma centers, a total of 501 patients received either prehospital plasma resuscitation, or standard-care resuscitation (saline or red blood cells).  

Blood banks break down blood into several components and use it for different life-saving circumstances. Plasma, which is a yellowish liquid that helps blood clot, is one of those components and has a longer shelf life when frozen. Thawed plasma was used during the PAMPer trial, which lasts for five days. Air transport teams noted the expiration date and discarded or recycled unused plasma. 

“The LifeFlight team couldn’t have been more supportive of this. The flight crews were excited and proud of the work they’ve done to contribute to science,” said Judy Jenkins, RN, MSN, CCRP, manager of Research Projects, who worked in the Division of Trauma and Surgical Critical Care during this study and is now part of the Vanderbilt Coordinating Center. “It couldn’t have been a better partnership. We couldn’t sing their praises enough,” Jenkins adds.

In the national study, out of the 501patients who received plasma 76.8 percent were still alive. Sixty-seven percent of patients who received standard care survived. Plasma patients also had lower 24-hour and in-hospital mortality. 

“This study was labor intensive, but in the end you are going to change the way people practice, and you are going to improve the survival of the most critically injured patients that we have, and that is very satisfying,” said Miller. 

Additional authors on this research are from University of Pittsburg School of Medicine, Jason Sperry, MD; Joshua Brown, MD, MSc; Louis Alarcon, MD; Brian Zuckerbraun, MD; Matthew Neal, MD; Matthew Rosengart, MD, MPH; Raquel Forsythe, MD; Timothy Billiar, MD; Andrew Peitzman, MD;  Mazen Zenati, MD; Ph.D., Clifton Callaway, MD, PhD; Donald Yealy, MD; Mark Yazer, MD; Darrell Triulzi, MD; Barbara Early-Young, BSN; Peter Adams, BS, and A. Tyler Putnam, MD; all of Pitt or UPMC, or both; Brian Daley, MD, University of Tennessee; Brian Harbrecht, MD, University of Louisville; Jeffrey Claridge, MD, MetroHealth Medical Center/Case Western Reserve University; Herb Phelan, MD, MSCS, University of Texas Southwestern/Parkland Memorial Hospital; William Witham, MD, Texas Health Harris Methodist Hospital; and Therese Duane, MD, John Peter Smith Health Network.

This research was funded by U.S. Army Medical Research and Material Command grant number W81XWH-12-2-0023.