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.
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References
- Increasing trauma deaths in the United States.Ann Surg. 2014; 260: 13-21
- Hemorrhagic shock.N Engl J Med. 2018; 378: 370-379
- Early prehospital tranexamic acid following injury is associated with a 30-day survival benefit: a secondary analysis of a randomized clinical trial.Ann Surg. 2021; 274: 419-426
- Association of prehospital plasma with survival in patients with traumatic brain injury: a secondary analysis of the PAMPer cluster randomized clinical trial.JAMA Netw Open. 2020; 3e2016869
- Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial.JAMA Surg. 2020; 156: 11-20
- Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock.N Engl J Med. 2018; 379: 315-326
- Prehospital blood product transfusion and combat injury survival-reply.JAMA. 2018; 319: 1167-1168
- Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.Scand J Trauma Resusc Emerg Med. 2016; 24: 145
- Severity of hemorrhage and the survival benefit associated with plasma: results from a randomized prehospital plasma trial.J Trauma Acute Care Surg. 2020; 88: 141-147
- Characterization of unexpected survivors following a prehospital plasma randomized trial.J Trauma Acute Care Surg. 2020; 89: 908-914
- Prehospital plasma is associated with distinct biomarker expression following injury.JCI Insight. 2020; 5e135350
- Prehospital plasma in injured patients is associated with survival principally in blunt injury: results from two randomized prehospital plasma trials.J Trauma Acute Care Surg. 2020; 88: 33-41
- Blood component use and injury characteristics of acute trauma patients arriving from the scene of injury or as transfers to a large, mature US Level 1 trauma center serving a large, geographically diverse region.Transfusion. 2021; 61: 3139-3149
- A national evaluation of the effect of trauma-center care on mortality.N Engl J Med. 2006; 354: 366-378
- The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments.J Trauma. Nov. 2007; 63: 965-971
- Prevalence of survivor bias in observational studies on fresh frozen plasma:erythrocyte ratios in trauma requiring massive transfusion.Anesthesiology. 2012; 116: 716-728
- Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality.J Trauma. 2010; 69 (discussion 599–601): 595-599
- Impact of interhospital transfer on outcomes for trauma patients: a systematic review.J Trauma. 2011; 71 (discussion 1901): 1885-1900
- Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial.Ann Surg. 2011; 253: 431-441
- Effect of out-of-hospital tranexamic acid vs placebo on 6-month functional neurologic outcomes in patients with moderate or severe traumatic brain injury.JAMA. 2020; 324: 961-974
- Massive transfusion and the response to prehospital plasma: it is all in how you define it.J Trauma Acute Care Surg. 2020; 89: 43-50
- Association of prehospital plasma transfusion with survival in trauma patients with hemorrhagic shock when transport times are longer than 20 minutes: a post hoc analysis of the PAMPer and COMBAT clinical trials.JAMA Surg. 2020; 155e195085
- The effect of interfacility transfer on outcome in an urban trauma system.J Trauma. 2003; 55: 444-449
- Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury.J Trauma. 2006; 60 (discussion 1256): 1250-1256
- The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis.J Trauma Acute Care Surg. 2012; 72 (discussion 1515–7): 1510-1515
Article info
Publication history
Published online: July 18, 2022
Accepted:
April 29,
2022
Footnotes
Rachel E. Lewis, MD, and Sruthi L. Muluk, BA, are co-primary authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.