COMBAT - Plasma First During Ground Transport

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Written by Clay Smith

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Administration of plasma first for traumatic hemorrhagic shock when brought by ground did not change 28-day mortality.

Why does this matter?
Last month we covered PAMPer, that found improved survival when plasma was given first to patients with traumatic hemorrhagic shock who were brought by helicopter.  But does this work for ground crews with a much shorter transport time?

COMBAT - plasma doesn't work on the ground
This was a single center RCT that used an as-treated analysis of 125 adult patients with traumatic hemorrhagic shock who were given plasma or saline.  Shock was defined as: SBP ≤70 mm Hg or 71-90 mm Hg plus heart rate ≥108.  About half were blunt trauma and half penetrating.  Plasma was frozen in a thin bag, and they used a rapid defrost (3 minutes) and special storage in the vehicle.  Mortality at 28 days was statistically the same: 15% plasma vs. 10% saline, p = 0.37.  Transport times were 19 minutes in the plasma group; 16 minutes for control (saline). Transport time was double this in PAMPer (median time 40-42 minutes), which may explain why the advantageous effect of plasma was seen in that study and not this one.  The study was stopped for futility after 144 of the planned 150 patients were enrolled.  There were no adverse events in either group.

Source
Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial.  Lancet. 2018 Jul 28;392(10144):283-291. doi: 10.1016/S0140-6736(18)31553-8. Epub 2018 Jul 20.
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Reviewed by Thomas Davis

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