Prehospital resuscitation with plasma Flashcards
(1 cards)
PAMPer trial-
Rationale
evidence suggests that early institution of blood components that more closely resemble whole blood may help prevent trauma coagulopathy, downstream traumatic shock, and improve outcomes (“AKA haemostatic transfusion”)
Severely injured patients at risk for haemorrhagic shock, Prehospital plasma resuscitation, compared with standard-care resuscitation (not including plasma administration), reduce 30-day mortality?
AB group Plasma was initiated in prehospital setting by air transport team before other resuscitative fluids were given
Results:
Significantly lower 30day mortality in Plasma group
*number needed to prevent 1death at 30days was 10
*INR- lower in plasma group
Thoughts:
Questionable biological plausibility
#A 10% drop in mortality is a very large reduction for a single intervention of 600mls of plasma
#Unclear mechanism of action
#The large mortality benefit appears to have occurred very early (see KM curves) and a 8.2% mortality difference by 24hours
#The difference in INR (1.2 vs 1.3), although statistically significant, is unlikely to account for all of this mortality difference.
#Other potential mechanisms (?less crystalloid, less RBCs, anti-inflammatory effects) not clarified
