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.
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.
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
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