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