Katherine M Reitz1, Hunter B Moore, Frank X Guyette, Angela Sauaia, Anthony E Pusateri, Ernest E Moore, Adnan Hassoune, Michael P Chapman, Brian J Daley, Richard S Miller, Brian G Harbrecht, Jeffrey A Claridge, Herb A Phelan, Joshua B Brown, Brian S Zuckerbraun, Matthew D Neal, Mark H Yazer, Jason L Sperry. 1. From the Department of Surgery (K.M.R., A.H., J.B.B., B.S.Z., M.D.N., J.L.S.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery (H.B.M., A.S., E.E.M., M.P.C.), University of Colorado and Denver Health Medical Center, Denver, Colorado; Department of Emergency Medicine (F.X.G.), University of Pittsburgh, Pittsburgh, Pennsylvania; US Army Institute of Surgical Research (A.E.P.), JBSA Fort Sam Houston, San Antonio, Texas; Department of Surgery (B.J.D.), University of Tennessee Health Science Center, Knoxville; Department of Surgery (R.S.M.), Vanderbilt University Medical Center, Nashville, Tennessee; University of Louisville (B.G.H.), Louisville, Kentucky; MetroHealth Medical Center (J.A.C.), Case Western Reserve University, Cleveland, Ohio; Department of Surgery (H.A.P.), University of Texas Southwestern, Parkland Memorial Hospital, Dallas, Texas; Department of Pathology (M.H.Y.), University of Pittsburgh and Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
Abstract
INTRODUCTION: Recent evidence demonstrated that prehospital plasma in patients at risk of hemorrhagic shock was safe for ground transport and resulted in a 28-day survival benefit for air medical transport patients. Whether any beneficial effect of prehospital plasma varies across injury mechanism remains unknown. METHODS: We performed a secondary analysis using a harmonized data set derived from two recent prehospital plasma randomized trials. Identical inclusion/exclusion criteria and primary/secondary outcomes were used for the trials. Prehospital time, arrival shock parameters, and 24-hour transfusion requirements were compared across plasma and control groups stratified by mechanism of injury. Stratified survival analysis and Cox hazard regression were performed to determine the independent survival benefits of plasma across blunt and penetrating injury. RESULTS: Blunt patients had higher injury severity, were older, and had a lower Glasgow Coma Scale. Arrival indices of shock and coagulation parameters were similar across blunt and penetrating injury. The percentage of patients with a prehospital time less than 20 minutes was significantly higher for penetrating patients relative to blunt injured patients (28.0% vs. 11.6%, p < 0.01). Stratified Kaplan-Meier curves demonstrated a significant separation for blunt injured patients (n = 465, p = 0.01) with no separation demonstrated for penetrating injured patients (n = 161, p = 0.60) Stratified Cox hazard regression verified, after controlling for all important confounders, that prehospital plasma was associated with a 32% lower independent hazard for 28-day mortality in blunt injured patients (hazard ratio, 0.68; 95% confidence interval, 0.47-0.96; p = 0.03) with no independent survival benefit found in penetrating patients (hazard ratio, 1.16; 95% confidence interval, 0.4-3.1; p = 0.78). CONCLUSION: A survival benefit associated with prehospital plasma at 24 hours and 28 days exists primarily in blunt injured patients with no benefit shown in penetrating trauma patients. No detrimental effects attributable to plasma are demonstrated in penetrating injury. These results have important relevance to military and civilian trauma systems. LEVEL OF EVIDENCE: Therapeutic, I.
INTRODUCTION: Recent evidence demonstrated that prehospital plasma in patients at risk of hemorrhagic shock was safe for ground transport and resulted in a 28-day survival benefit for air medical transport patients. Whether any beneficial effect of prehospital plasma varies across injury mechanism remains unknown. METHODS: We performed a secondary analysis using a harmonized data set derived from two recent prehospital plasma randomized trials. Identical inclusion/exclusion criteria and primary/secondary outcomes were used for the trials. Prehospital time, arrival shock parameters, and 24-hour transfusion requirements were compared across plasma and control groups stratified by mechanism of injury. Stratified survival analysis and Cox hazard regression were performed to determine the independent survival benefits of plasma across blunt and penetrating injury. RESULTS: Blunt patients had higher injury severity, were older, and had a lower Glasgow Coma Scale. Arrival indices of shock and coagulation parameters were similar across blunt and penetrating injury. The percentage of patients with a prehospital time less than 20 minutes was significantly higher for penetrating patients relative to blunt injured patients (28.0% vs. 11.6%, p < 0.01). Stratified Kaplan-Meier curves demonstrated a significant separation for blunt injured patients (n = 465, p = 0.01) with no separation demonstrated for penetrating injured patients (n = 161, p = 0.60) Stratified Cox hazard regression verified, after controlling for all important confounders, that prehospital plasma was associated with a 32% lower independent hazard for 28-day mortality in blunt injured patients (hazard ratio, 0.68; 95% confidence interval, 0.47-0.96; p = 0.03) with no independent survival benefit found in penetrating patients (hazard ratio, 1.16; 95% confidence interval, 0.4-3.1; p = 0.78). CONCLUSION: A survival benefit associated with prehospital plasma at 24 hours and 28 days exists primarily in blunt injured patients with no benefit shown in penetrating trauma patients. No detrimental effects attributable to plasma are demonstrated in penetrating injury. These results have important relevance to military and civilian trauma systems. LEVEL OF EVIDENCE: Therapeutic, I.
Authors: Joshua B Brown; Jason L Sperry; Anisleidy Fombona; Timothy R Billiar; Andrew B Peitzman; Francis X Guyette Journal: J Am Coll Surg Date: 2015-01-24 Impact factor: 6.113
Authors: Chantal Forristal; Kristine Van Aarsen; Melanie Columbus; James Wei; Kelly Vogt; Sameer Mal Journal: Prehosp Emerg Care Date: 2019-04-19 Impact factor: 3.077
Authors: Joshua B Brown; Mitchell J Cohen; Joseph P Minei; Ronald V Maier; Michaela A West; Timothy R Billiar; Andrew B Peitzman; Ernest E Moore; Joseph Cuschieri; Jason L Sperry Journal: Ann Surg Date: 2015-05 Impact factor: 12.969
Authors: Hunter B Moore; Ernest E Moore; Michael P Chapman; Kevin McVaney; Gary Bryskiewicz; Robert Blechar; Theresa Chin; Clay Cothren Burlew; Fredric Pieracci; F Bernadette West; Courtney D Fleming; Arsen Ghasabyan; James Chandler; Christopher C Silliman; Anirban Banerjee; Angela Sauaia Journal: Lancet Date: 2018-07-20 Impact factor: 79.321
Authors: Jason L Sperry; Francis X Guyette; Joshua B Brown; Mark H Yazer; Darrell J Triulzi; Barbara J Early-Young; Peter W Adams; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herb A Phelan; William R Witham; A Tyler Putnam; Therese M Duane; Louis H Alarcon; Clifton W Callaway; Brian S Zuckerbraun; Matthew D Neal; Matthew R Rosengart; Raquel M Forsythe; Timothy R Billiar; Donald M Yealy; Andrew B Peitzman; Mazen S Zenati Journal: N Engl J Med Date: 2018-07-26 Impact factor: 91.245
Authors: Hunter B Moore; Matthew T Tessmer; Ernest E Moore; Jason L Sperry; Mitchell J Cohen; Michael P Chapman; Anthony E Pusateri; Francis X Guyette; Joshua B Brown; Matthew D Neal; Brian Zuckerbraun; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2020-05 Impact factor: 3.313
Authors: Danielle S Gruen; Joshua B Brown; Francis X Guyette; Yoram Vodovotz; Pär I Johansson; Jakob Stensballe; Derek A Barclay; Jinling Yin; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herb A Phelan; Matthew D Neal; Brian S Zuckerbraun; Timothy R Billiar; Jason L Sperry Journal: JCI Insight Date: 2020-04-23
Authors: Danielle S Gruen; Francis X Guyette; Joshua B Brown; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herb A Phelan; Mark H Yazer; Matthew D Neal; Brian S Zuckerbraun; Jason L Sperry Journal: J Trauma Acute Care Surg Date: 2020-11 Impact factor: 3.697
Authors: Katherine M Reitz; Danielle S Gruen; Frances Guyette; Joshua B Brown; Mark H Yazer; Yoram Vodovotz; Pär I Johanssen; Jakob Stensballe; Brian Daley; Richard S Miller; Brian G Harbrecht; Jeffrey Claridge; Herb A Phelan; Matthew D Neal; Brian S Zuckerbraun; Jason L Sperry Journal: Trauma Surg Acute Care Open Date: 2021-02-11
Authors: Alexander F Bedard; Lina V Mata; Chelsea Dymond; Fabio Moreira; Julia Dixon; Steven G Schauer; Adit A Ginde; Vikhyat Bebarta; Ernest E Moore; Nee-Kofi Mould-Millman Journal: Int J Emerg Med Date: 2020-12-09
Authors: Shimena R Li; Francis Guyette; Joshua Brown; Mazen Zenati; Katherine M Reitz; Brian Eastridge; Raminder Nirula; Gary A Vercruysse; Terence O'Keeffe; Bellal Joseph; Matthew D Neal; Brian S Zuckerbraun; Jason L Sperry Journal: Ann Surg Date: 2021-09-01 Impact factor: 13.787
Authors: Danielle S Gruen; Francis X Guyette; Joshua B Brown; David O Okonkwo; Ava M Puccio; Insiyah K Campwala; Matthew T Tessmer; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herb A Phelan; Matthew D Neal; Brian S Zuckerbraun; Mark H Yazer; Timothy R Billiar; Jason L Sperry Journal: JAMA Netw Open Date: 2020-10-01