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The Israel Defense Forces experience with freeze-dried plasma for the resuscitation of traumatized pediatric patients

Nadler, Roy MD; Mozer-Glassberg, Yael MD; Gaines, Barbara MD; Glassberg, Elon MD, MHA; Chen, Jacob MD, MHA

Journal of Trauma and Acute Care Surgery: December 2019 - Volume 87 - Issue 6 - p 1315–1320
doi: 10.1097/TA.0000000000002477

BACKGROUND With the growing recognition of the disadvantages of crystalloid- and colloid-based resuscitation and the advantages of using blood products as the preferred resuscitation fluid, the Israel Defense Forces Medical Corps (IDF-MC) adopted plasma as the primary volume resuscitation regimen in 2013. While data are accumulating for prehospital plasma transfusion, little to no data exist regarding using plasma as a prehospital resuscitation fluid for traumatized pediatric patients.

METHODS All patients treated by the IDF-MC personnel are recorded in the IDF Trauma Registry, a unique prehospital trauma registry. All patients treated by the IDF advanced life support providers with FDP at the point of injury between April 2013 and June 2018 who were younger than 18 years at the time of injury were included.

RESULTS Six hundred seventy-nine children were treated by IDF medical providers, of whom 33 (5%) were identified in the IDF Trauma Registry as having received FDP at the point of injury. Most patients (80%) were treated for penetrating injuries. Most patients received one plasma unit. Fifty-four percent of the patients were also treated by Tranexamic Acid (TXA) and 48% were transfused with crystalloids. In 33% of patients, additional life-saving interventions were performed.

CONCLUSION While the ideal resuscitation fluid for the pediatric population remains to be determined, it seems reasonable to pursue a similar approach to that of applied that for adults. In the IDF-MC, the resuscitation fluid of choice for trauma patients in hemorrhagic shock is freeze-dried plasma transfused at the point of injury. The current study demonstrates the feasibility of FDP administration in the prehospital scenario for injured children and further supports the growing confidence in the use of FDP for the treatment of pediatric trauma patients.

LEVEL OF EVIDENCE Retrospective descriptive study, level IV.

From the Surgeon General's HQ, Israel Defense Force (R.N., E.G., J.C.); Department of Surgery and Transplantation B (R.N.), Chaim Sheba Medical Center, Ramat Gan, Israel; The Institute of Gastroenterology, Nutrition and Liver Diseases (M.-G.Y.), Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Department of Surgery (B.G.), Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; and The Azrieli Faculty of Medicine (B.G.), Bar-Ilan University, Safed, Israel.

Submitted: May 16, 2019, Revised: August 1, 2019, Accepted: August 2, 2019, Published online: August 14, 2019.

R.N. and M.-G.Y. declare equal contribution.

Address for reprints: Roy Nadler, MD, The Trauma and Combat Medicine Branch, Medical Corps, Surgeon General's Headquarters. Military POB 02149. Israel Defense Forces, Ramat Gan, Israel; email:

Online date: August 16, 2019

© 2019 Lippincott Williams & Wilkins, Inc.