New Guideline Calls for Quicker Delivery of Plasma for Trauma Patients
October 6th, 2016
TUCSON, AZ – Emergency physicians are well aware of the agonizing wait for trauma patients to receive plasma, knowing that more of them would survive if the product could be delivered more quickly.
A new study on a rapid deployment plasma protocol, published recently in the journal Transfusion, points out that the traditional way of giving patients plasma involves two time-consuming steps – testing for blood type and then thawing frozen plasma – but maintains the process doesn’t have to take 30 or more minutes, as it usually does now.
"There's a golden hour after trauma where you need to be able to stabilize the patient," explained lead study author Deborah Novak, MD, of the University of Arizona in Tucson.
Through the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) clinical trial conducted at 12 urban trauma centers, researchers determined that trauma teams using a new clinical guideline could consistently deliver plasma to trauma patients three times faster than the traditional delivery method.
The new guideline calls for delivering thawed plasma to trauma patients’ bedsides within 10 minutes of arrival; 11of 12 sites were consistently able to deliver six units of thawed universal donor plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Approximately 4,700 units of plasma were given to the 680 patients enrolled in the trial in which investigators evaluated the utility of guidelines for massive transfusion developed by the American College of Surgeons Trauma Quality Improvement Program.
Traditional trauma resuscitation involves giving the patient crystalloid fluids and red blood cells early on, and then administering plasma and platelets later, according to background information in the report, which notes that plasma is typically stored frozen and thawed only when trauma staff request it.
The method successfully treats most trauma victims with mild or moderate injuries, according to study authors, but military and civilian researchers have found that individuals with massive bleeding benefit when they receive plasma at the same ratio as red blood cells.
"A renewed look at the process resulted in the concept of transfusing plasma earlier, with red blood cells and plasma in ratios that approximate the reconstitution of the original unit of whole blood," Novak pointed out, adding that less blood was wasted than researchers had feared.
While PROPPR focuses on the use of universal-donor plasma, three trial sites used blood type A plasma instead without complications because universal-donor plasma was scarce, which ended up being an important side note of the trial, Novak noted.
"What we found out and what other places have found is that trauma teams can safely use AB or limited amounts of A plasma for that small window when the patient's blood type is not yet known," she said, emphasizing that the finding could help sustain supplies of unthawed plasma for trauma use.