R. Lewis1, J. Sperry2, F. Guyette3, R. Miller3, B. Harbrecht4, J. Claridge5, H. Phelan6, J. Brown2, M. Yazer2, B. Daley1 1University of Tennessee Medical Center,Surgery,Knoxville, TN, USA 2University Of Pittsburg,Surgery,Pittsburgh, PA, USA 3Vanderbilt University Medical Center,Surgery,Nashville, TN, USA 4University Of Louisville,Surgery,Louisville, KY, USA 5MetroHealth Medical Center,Surgery,Cleveland, OH, USA 6University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA
Introduction:
We sought to determine if air medical transport from the scene of injury (SCN) or from a referral hospital (REF) alters the outcome effects of prehospital plasma in patients at risk of hemorrhagic shock.
Methods:
We performed a secondary analysis of data from a recently completed prehospital plasma clinical trial. All enrolled patients from either the SCN or REF were included. Demographics, injury characteristics, shock severity and resuscitation needs were compared. The primary outcome was 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, REF patients (n=111) accounted for 22% with the remaining (n=390) originating from the scene. Overall mortality was 28% with a median ISS of 22 (IQR 13,30). SCN patients had higher injury severity and were more likely intubated prehospital. REF patients had a higher rate of penetrating injury, longer prehospital times and received greater prehospital crystalloid and blood products. Prehospital shock, GCS and the incidence of traumatic brain injury was similar across groups. Kaplan-Meier analysis revealed a significant survival benefit associated with prehospital plasma in the SCN group (p=0.003) with no difference found in REF patients (p=0.37). Cox-regression verified after controlling for relevant confounders that prehospital plasma was independently associated with survival in SCN patients (HR 1.7 95CI 1.2-2.7, p=0.007) [Figure 1] with no benefit found in REF patients (HR 0.87 95CI 0.3-2.7, p=0.760) [Figure 2].
Conclusion:
Important differences across SCN and REF cohorts exist that are essential to understand when planning prehospital studies. Prehospital plasma is associated with a survival benefit primarily in SCN patients. Specific injury characteristics of SCN patients may be important determinants of an early plasma benefit.
