While traumatic injury is the leading cause of death among people under age 45, if given plasma quickly, they will have a better chance at survival. Now, a new protocol from the American College of Surgeons aims to reduce the average wait time of 30 minutes or longer for plasma.
Based on a study at 12 urban trauma centers, researchers found that trauma teams could consistently deliver plasma to trauma patients three times faster than the traditional delivery method using the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) clinical guideline. Within 10 minutes, thawed plasma could be at the patient’s bedside, the study — published in the June issue of Transfusion — found.1
Traditional trauma resuscitation involves giving the patient non-blood fluids, called crystalloid fluids, and red blood cells early on, and then administering plasma and platelets later. Plasma is typically stored frozen and thawed only when trauma staff request it. While this method successfully treats most trauma victims with mild or moderate injuries, military and civilian researchers have found that individuals with massive bleeding benefit when they received plasma at the same ratio as red blood cells.1
PROPPR focuses on the use of universal-donor plasma — that is, plasma that can be given to all blood types. But, because thawed, universal-donor plasma can be scarce at times, three trial sites used blood type A plasma and found it could be used without complications — an important side-finding of the study.1
The challenge is to have plasma thawed and ready when the patient arrives at the emergency room, since it has to be discarded after five days, while frozen plasma can last up to a year. The study participants found that the key to reducing waste was to balance the amount of pre-thawed plasma with total plasma use. Only one of the sites had waste of 25%. The rest had less than 10% wastage.1
Overcoming the challenge of getting thawed plasma rapidly into the trauma unit was an essential component of the PROPPR trial. Eleven of the 12 sites were able to consistently delivery six units of thawed plasma to the patient’s bedside within 10 minutes of arrival. The twelfth site, which had only two trauma patients a month, was able to do so within 15 minutes.1
- Novak DJ, Bai Y, Cooke, RK, et al. Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial. Transfusion. 2015 Mar 30. doi: 10.1111/trf.13098. [Epub ahead of print]