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Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock.
Sperry, Jason L; Guyette, Francis X; Brown, Joshua B; Yazer, Mark H; Triulzi, Darrell J; Early-Young, Barbara J; Adams, Peter W; Daley, Brian J; Miller, Richard S; Harbrecht, Brian G; Claridge, Jeffrey A; Phelan, Herb A; Witham, William R; Putnam, A Tyler; Duane, Therese M; Alarcon, Louis H; Callaway, Clifton W; Zuckerbraun, Brian S; Neal, Matthew D; Rosengart, Matthew R; Forsythe, Raquel M; Billiar, Timothy R; Yealy, Donald M; Peitzman, Andrew B; Zenati, Mazen S.
Afiliação
  • Sperry JL; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Guyette FX; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Brown JB; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Yazer MH; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Triulzi DJ; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Early-Young BJ; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Adams PW; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Daley BJ; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Miller RS; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Harbrecht BG; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Claridge JA; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Phelan HA; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Witham WR; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Putnam AT; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Duane TM; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Alarcon LH; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Callaway CW; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Zuckerbraun BS; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Neal MD; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Rosengart MR; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Forsythe RM; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Billiar TR; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Yealy DM; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Peitzman AB; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
  • Zenati MS; From the Division of Trauma and General Surgery, Department of Surgery (J.L.S., J.B.B., L.H.A., B.S.Z., M.D.N., M.R.R., R.M.F., T.R.B., A.B.P., M.S.Z.), and the Departments of Emergency Medicine (F.X.G., C.W.C., D.M.Y.) and Critical Care Medicine (B.J.E.-Y., P.W.A.), University of Pittsburgh Medical
N Engl J Med ; 379(4): 315-326, 2018 Jul 26.
Article em En | MEDLINE | ID: mdl-30044935
ABSTRACT

BACKGROUND:

After a person has been injured, prehospital administration of plasma in addition to the initiation of standard resuscitation procedures in the prehospital environment may reduce the risk of downstream complications from hemorrhage and shock. Data from large clinical trials are lacking to show either the efficacy or the risks associated with plasma transfusion in the prehospital setting.

METHODS:

To determine the efficacy and safety of prehospital administration of thawed plasma in injured patients who are at risk for hemorrhagic shock, we conducted a pragmatic, multicenter, cluster-randomized, phase 3 superiority trial that compared the administration of thawed plasma with standard-care resuscitation during air medical transport. The primary outcome was mortality at 30 days.

RESULTS:

A total of 501 patients were evaluated 230 patients received plasma (plasma group) and 271 received standard-care resuscitation (standard-care group). Mortality at 30 days was significantly lower in the plasma group than in the standard-care group (23.2% vs. 33.0%; difference, -9.8 percentage points; 95% confidence interval, -18.6 to -1.0%; P=0.03). A similar treatment effect was observed across nine prespecified subgroups (heterogeneity chi-square test, 12.21; P=0.79). Kaplan-Meier curves showed an early separation of the two treatment groups that began 3 hours after randomization and persisted until 30 days after randomization (log-rank chi-square test, 5.70; P=0.02). The median prothrombin-time ratio was lower in the plasma group than in the standard-care group (1.2 [interquartile range, 1.1 to 1.4] vs. 1.3 [interquartile range, 1.1 to 1.6], P<0.001) after the patients' arrival at the trauma center. No significant differences between the two groups were noted with respect to multiorgan failure, acute lung injury-acute respiratory distress syndrome, nosocomial infections, or allergic or transfusion-related reactions.

CONCLUSIONS:

In injured patients at risk for hemorrhagic shock, the prehospital administration of thawed plasma was safe and resulted in lower 30-day mortality and a lower median prothrombin-time ratio than standard-care resuscitation. (Funded by the U.S. Army Medical Research and Materiel Command; PAMPer ClinicalTrials.gov number, NCT01818427 .).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Etiology_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Clinical_trials / Etiology_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article