Plyo prehospitalier: N'améliore pas la survie ?

The impact of prehospital administration of freeze-dried plasma on casualty outcome.

Shlaifer A et Al. J Trauma Acute Care Surg. 2019 Jan;86(1):108-115

-------------------------------

Ce travail qui porte sur l'étude de l'impact, chez des blessés en choc hémorragique,  de la perfusion préhospitalière de PLyo confirme son intérêt en terme d'économie transfusionnelle mais pas en terme de mortalité. Les auteurs mettent en avant la taille de leur cohorte de blessés pour expliquer ce résultat négatif. On notera également les délais courts de transport.

-------------------------------

 

BACKGROUND:

Hemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma-induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty's remaining factors. The Israel Defense Force Medical Corps decided to use freeze-dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting. The aim of our study is to compare the differences of coagulation, perfusion measurements, resource utilization, and outcome between casualties receiving FDP to casualties who did not receive FDP in the prehospital setting.

METHODS:

This is a retrospective matched cohort study based on two groups of casualties (those treated with FDP vs. those without FDP treatment). The control group was compiled in three steps of precision for age, sex, mechanism of injury and maximum level of severity for each nine injured body regions. Data were collected from the IDF Trauma Registry and The National Israel Trauma Registry.

RESULTS:

The study group comprised 48 casualties receiving FDP and 48 controls with no differences in demographic, evacuation time, and injury characteristics. The FDP group demonstrated a lower level of hemoglobin (12.7 gr/dzl) (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.10-8.80), lower level of international normalized ratio (1.1) (OR, 3.09; 95% CI, 1.04-9.14), and lower level of platelets (230 × 109/L) (OR, 3.06; 95% CI, 1.16-8.06). No other differences were found between the two groups.

 

" In the total study population, seven (7.3%) casualties died in hospital, among which 8.3% were from the FDP group, compared with 6.2% from the control group"

CONCLUSION:

The use of FDP in the prehospital setting has logistic benefits and a positive effect on coagulation profile, with no other significant effects. Future studies need to be performed on larger groups to verify trends or nullify our hypotheses.