PAMPer
Trial question
What is the role of prehospital administration of thawed plasma during air medical transport in trauma patients at risk for hemorrhagic shock?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
27.0% female
73.0% male
N = 501
501 patients (137 female, 364 male)
Inclusion criteria: injured patients who were at risk for hemorrhagic shock during air medical transport to a trauma center
Key exclusion criteria: older than 90 years of age or younger than 18 years of age, non-establishment of intravenous or intraosseous access, cervical cord injury, penetrating brain injury, injury due to isolated drowning, or hanging
Interventions
N=230 plasma (administration of 2 units of thawed plasma initiated in the prehospital setting by the air transport team)
N=271 standard care (resuscitation with the infusion of a crystalloid solution as the primary resuscitative fluid during the flight)
Primary outcome
Death at 30 days
23.2
33
33.0 %
24.8 %
16.5 %
8.3 %
0.0 %
Plasma
Standard
care
Significant
decrease ▼
NNT = 10
Significant decrease in death at 30 days (23.2% vs. 33%; ARD -9.8, 95% CI -18.6 to -1)
Secondary outcomes
Significant decrease in death within 24 hours (13.9% vs. 22.1%; ARD -8.2, 95% CI -14.9 to -1.6)
Significant decrease in death in the hospital (22.2% vs. 32.5%; ARD -10.3, 95% CI -18 to -2.6)
No significant difference in multiorgan failure (63% vs. 57.6%; AD 5.4%, 95% CI -3.1 to 14.1)
Safety outcomes
No significant differences in acute lung injury-ARDS, nosocomial infection, allergic reaction or transfusion-related reaction.
Significant difference in prothrombin-time ratio (1.2 vs. 1.3).
Conclusion
In injured patients who were at risk for hemorrhagic shock during air medical transport to a trauma center, plasma was superior to standard care with respect to death at 30 days.
Reference
Jason L Sperry, Francis X Guyette, Joshua B Brown et al. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med. 2018 Jul 26;379(4):315-326.
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