EMS World

DEC 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 60 of 83

60 DECEMBER 2018 | EMSWORLD.com EVIDENCE-BASED MEDICINE less than 90) and tachycardia (HR greater than 108). The plasma was given prior to any crystalloids. Based on local protocol and availability, some patients in both the plasma and control groups also received packed red blood cells (PRBCs). Patients were transported by aircraft from 27 bases to nine trauma centers, and 564 were included, with 230 get- ting pla sma and 27 1 getting standard therapy. Most of these patient s were male (7 3%), had blunt trauma (82%), and got an operation within the first 24 hours (58%). More than half (51%) had prehospital intubation, 35% got PRBCs, and the median injur y severity score was 22. The groups were well matched among these factors. The primar y outcome was 30-day mortality. Those patients receiving plasma had a mortality rate of 23.2% vs. 33% in the s tandard care group, a dif ference of -9.8% (95% CI, [-18.6%]–[-1.0%]). The odds ratio for death with pla sma vs . standard therapy was 0.61 (0.40–0.91), meaning the odds were 39% lower if given plasma. My calculations show this 10% decrease in mortality resulting in a number needed to treat to save one life of 10. That is a ver y impressive number. For context, the NNT to save one life with aspirin when experiencing a STEMI is 42. There were no dif ferences in trans- f usio n - relate d lung injur y o r aller gic reactions. The main factor limiting this therapy in the field is logistics. The shelf- life on thawed plasma is five days. It is expensive and requires specific mainte- nance. These logistic restrictions make the use of thawed plasma, even with its impressive mortality benefit, impractical. The good news, however, is that a much more stable plasma product has been developed and successfully deployed. The Israel Defense Forces uses freeze- dried plasma for severe trauma. A U.S. version of this product is under review, with hopes of approval in 2020. The goal would be a produc t that is stable for more than a year at room temperature and needs only reconstitution with 200 ml of saline. If no problems arise with this and it get s approval, pla sma could become Logistic restrictions make thawed plasma, even with its impressive mortality benefit, impractical. The good news is that a more stable plasma product has been developed. The PAMPer trial examined 564 patients who were transported by air to trauma centers.

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