Prehospital Plasma Resuscitation Associated With Improved Neurologic Outcomes After Traumatic Brain Injury

Matthew C. Hernandez, Cornelius A. Thiels, Johnathon M. Aho, Elizabeth B Habermann, Martin D. Zielinski, James A. Stubbs, Donald H. Jenkins, Scott P. Zietlow

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

INTRODUCTION: Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. METHODS: We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBC) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow up. RESULTS: Of 76 patients meeting inclusion criteria 53% (n=40) received pre-hospital pRBC and 47% (n=36) received thawed plasma. Age, gender, injury severity (ISS) or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p>0.05). Patients that received thawed plasma had an improved neurologic outcome compared to those receiving pRBC (median GOSE 7 [7-8] vs 5.5 [3-7], p<0.001). Additionally, patients that received thawed plasma had improved functionality compared to pRBC (median DRS 2 [1-3.5] vs 9 [3-13], p<0.001). Calculated GOSE and DRS scores during follow up, median 6 [5-7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBC by both median GOSE (8 [7-8] vs 6 [6-7] p<0.001) and DRS (0 [0-1] vs 4 [2-8] p<0.001). CONCLUSION: In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow up compared to pRBC alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. LEVEL OF EVIDENCE: Level V – Retrospective Study STUDY TYPE: Retrospective single institution study

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - May 22 2017

Fingerprint

Resuscitation
Nervous System
Erythrocytes
Wounds and Injuries
Hypotension
Traumatic Brain Injury
Trauma Centers
Colloids
Craniocerebral Trauma
Anticoagulants
Brain Injuries
Retrospective Studies

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Prehospital Plasma Resuscitation Associated With Improved Neurologic Outcomes After Traumatic Brain Injury. / Hernandez, Matthew C.; Thiels, Cornelius A.; Aho, Johnathon M.; Habermann, Elizabeth B; Zielinski, Martin D.; Stubbs, James A.; Jenkins, Donald H.; Zietlow, Scott P.

In: Journal of Trauma and Acute Care Surgery, 22.05.2017.

Research output: Contribution to journalArticle

Hernandez, Matthew C. ; Thiels, Cornelius A. ; Aho, Johnathon M. ; Habermann, Elizabeth B ; Zielinski, Martin D. ; Stubbs, James A. ; Jenkins, Donald H. ; Zietlow, Scott P. / Prehospital Plasma Resuscitation Associated With Improved Neurologic Outcomes After Traumatic Brain Injury. In: Journal of Trauma and Acute Care Surgery. 2017.
@article{ab3d121894e045fbaa918acf42647d2e,
title = "Prehospital Plasma Resuscitation Associated With Improved Neurologic Outcomes After Traumatic Brain Injury",
abstract = "INTRODUCTION: Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. METHODS: We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBC) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow up. RESULTS: Of 76 patients meeting inclusion criteria 53{\%} (n=40) received pre-hospital pRBC and 47{\%} (n=36) received thawed plasma. Age, gender, injury severity (ISS) or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p>0.05). Patients that received thawed plasma had an improved neurologic outcome compared to those receiving pRBC (median GOSE 7 [7-8] vs 5.5 [3-7], p<0.001). Additionally, patients that received thawed plasma had improved functionality compared to pRBC (median DRS 2 [1-3.5] vs 9 [3-13], p<0.001). Calculated GOSE and DRS scores during follow up, median 6 [5-7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBC by both median GOSE (8 [7-8] vs 6 [6-7] p<0.001) and DRS (0 [0-1] vs 4 [2-8] p<0.001). CONCLUSION: In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow up compared to pRBC alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. LEVEL OF EVIDENCE: Level V – Retrospective Study STUDY TYPE: Retrospective single institution study",
author = "Hernandez, {Matthew C.} and Thiels, {Cornelius A.} and Aho, {Johnathon M.} and Habermann, {Elizabeth B} and Zielinski, {Martin D.} and Stubbs, {James A.} and Jenkins, {Donald H.} and Zietlow, {Scott P.}",
year = "2017",
month = "5",
day = "22",
doi = "10.1097/TA.0000000000001581",
language = "English (US)",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Prehospital Plasma Resuscitation Associated With Improved Neurologic Outcomes After Traumatic Brain Injury

AU - Hernandez, Matthew C.

AU - Thiels, Cornelius A.

AU - Aho, Johnathon M.

AU - Habermann, Elizabeth B

AU - Zielinski, Martin D.

AU - Stubbs, James A.

AU - Jenkins, Donald H.

AU - Zietlow, Scott P.

PY - 2017/5/22

Y1 - 2017/5/22

N2 - INTRODUCTION: Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. METHODS: We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBC) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow up. RESULTS: Of 76 patients meeting inclusion criteria 53% (n=40) received pre-hospital pRBC and 47% (n=36) received thawed plasma. Age, gender, injury severity (ISS) or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p>0.05). Patients that received thawed plasma had an improved neurologic outcome compared to those receiving pRBC (median GOSE 7 [7-8] vs 5.5 [3-7], p<0.001). Additionally, patients that received thawed plasma had improved functionality compared to pRBC (median DRS 2 [1-3.5] vs 9 [3-13], p<0.001). Calculated GOSE and DRS scores during follow up, median 6 [5-7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBC by both median GOSE (8 [7-8] vs 6 [6-7] p<0.001) and DRS (0 [0-1] vs 4 [2-8] p<0.001). CONCLUSION: In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow up compared to pRBC alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. LEVEL OF EVIDENCE: Level V – Retrospective Study STUDY TYPE: Retrospective single institution study

AB - INTRODUCTION: Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. METHODS: We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBC) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow up. RESULTS: Of 76 patients meeting inclusion criteria 53% (n=40) received pre-hospital pRBC and 47% (n=36) received thawed plasma. Age, gender, injury severity (ISS) or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p>0.05). Patients that received thawed plasma had an improved neurologic outcome compared to those receiving pRBC (median GOSE 7 [7-8] vs 5.5 [3-7], p<0.001). Additionally, patients that received thawed plasma had improved functionality compared to pRBC (median DRS 2 [1-3.5] vs 9 [3-13], p<0.001). Calculated GOSE and DRS scores during follow up, median 6 [5-7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBC by both median GOSE (8 [7-8] vs 6 [6-7] p<0.001) and DRS (0 [0-1] vs 4 [2-8] p<0.001). CONCLUSION: In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow up compared to pRBC alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. LEVEL OF EVIDENCE: Level V – Retrospective Study STUDY TYPE: Retrospective single institution study

UR - http://www.scopus.com/inward/record.url?scp=85019594682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019594682&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001581

DO - 10.1097/TA.0000000000001581

M3 - Article

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

ER -