Prehospital plasma tied to better outcomes in trauma patients: COMBAT and PAMPer

  • Pusateri AE & al.
  • JAMA Surg
  • 18 dic. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • This combined analysis of 2 trials found lower mortality among trauma patients receiving prehospital plasma.
  • Plasma mitigated the higher mortality among patients experiencing longer transport times.

Why this matters

  • COMBAT and PAMPer, whose designs were harmonized, came to contradictory conclusions about the benefit of prehospital plasma for trauma patients.
  • COMBAT had short transport times, so prehospital transfusion saved little time. 

Key results

  • Plasma vs standard care only: 
    • 28-day mortality, adjusted for injury severity, age, and COMBAT vs PAMPer: HR, 0.65 (95% CI, 0.47-0.90; P=.01).
    • 24-hour mortality: HR, 0.62 (95% CI, 0.42-0.93; P=.02).
  • Mortality when prehospital transport took >20 vs ≤20 minutes:
    • Plasma group: HR, 0.78 (95% CI, 0.40-1.51; P=.46).
    • Standard care group: HR, 2.12 (95% CI, 1.05-4.30; P=.04).
  • Among patients with >20-minute transport time, the plasma group also experienced lower likelihood of coagulopathy vs the standard care group: OR, 0.53 (95% CI, 0.35-0.80; P=.002).
  • The plasma group also had lower transfusion requirements.

Study design

  • Post hoc analysis of COMBAT and PAMPer trials, in which trauma patients with hemorrhagic shock were randomly assigned to 2 U thawed plasma plus standard care vs standard care only during prehospital care (N=626).
  • Outcome: 28-day mortality.
  • Funding: US Army; NIH.

Limitations

  • 1 study used air ambulances, the other ground ambulances.