Prehospital Plasma Is Not Associated With an Increase in Orthopedic Trauma Patients With Hemorrhagic Shock That Meet Early Appropriate Care Criteria.

INTRODUCTION

The Prehospital Air Medical Plasma trial demonstrated that prehospital helicopter administration of thawed plasma versus standard of care (SOC) resuscitation reduced 30-d mortality in patients with hemorrhagic shock. There is no current analysis of patients who underwent orthopedic interventions. We aimed to determine if prehospital administration of plasma is associated with an increased proportion of patients that meet early appropriate care (EAC) criteria.

MATERIALS AND

METHODS

This was a secondary analysis of the subgroup of patients from the Prehospital Air Medical Plasma trial who had major orthopedic trauma injuries, including 156 patients with pelvis, acetabulum, spine, femur, and tibia fractures. Of these, 133 had at least one lab value (lactate, pH, and/or base deficit) to determine if they met criteria for EAC within the first 6 h of presentation. Patients were then grouped into those who received thawed plasma versus SOC (control).

RESULTS

Orthopedic injuries included 92 femur fractures, seven pelvis/acetabular fractures, three spine injuries, and 71 tibia fractures. In the final 133-patient cohort, 97 (72.9%) were male, and the average age was 44.8 y. Of 62 patients who received plasma, 55 (88.7%) met EAC criteria compared to 59 of 71 (83.1%) patients who did not receive plasma met EAC criteria (P = 0.36).

CONCLUSIONS

Patients presenting in hemorrhagic shock with orthopedic injuries who received prehospital administration of plasma compared to SOC resuscitation did not meet criteria for EAC at a significantly greater proportion. Further investigation is needed for interventions that will improve the frequency and speed at which orthopedic trauma patients meet EAC.