Two large studies have come to conflicting conclusions about whether emergency medical technicians should give plasma to severely bleeding trauma patients who are on their way to the hospital. But the disparity may be a function of the time it takes to get there.
The first, involving 125 trauma patients with presumed hemorrhagic shock and published in The Lancet, found that plasma administration did not improve mortality when the hospital was nearby.

The second, involving 501 patients who were airlifted to trauma center hospitals and released today in The New England Journal of Medicine (NEJM), found that giving plasma reduced the rate of death at 30 days by nearly 10 percentage points.

The authors of the Lancet study, known as COMBAT, speculated that plasma might be beneficial with longer transport times. That study was done in an urban area where it typically took less than 20 minutes to get to the hospital.

In the PAMPer study of patients taken to the hospital by helicopter, the trip typically took about 40 minutes.

The U.S. Department of Defense funded both trials. About 50,000 Americans die from injury-related hemorrhage each year, usually within two hours after their injury.

The results from the airlifted patients “should motivate trauma center personnel and air medical crews across the country to consider implementing this lifesaving approach,” said Dr. Jeremy Cannon of the University of Pennsylvania in a NEJM editorial.

“These results have the power to significantly alter trauma resuscitation,” co-author Jason Sperry, professor of surgery and critical care medicine at the University of Pittsburgh School of Medicine, said in a news release and video interview released by the school.
Adding 10 percentage points to the odds of survival “is going to have a robust benefit and it will change the way we practice pre-hospital care for the injured patient,” said Dr. Sperry, who was in Africa and unavailable for an interview.

The findings mean “it’s definitely feasible and it’s safe to administer blood products such as frozen plasma” in a pre-hospital setting, COMBAT co-author Dr. Michael Chapman of the University of Colorado School of Medicine told Reuters Health in a telephone interview.
“However, whatever benefits that can be seen probably won’t be realized in the short transport time to an urban trauma center,” he said. “But it seems reasonable to look at rural areas, developing countries and a military setting, where these benefits could realize themselves when ground transportation times are longer.”