A Systematic Review and Meta-Analysis of Prehospital Plasma Administration for Hemorrhagic Shock

Nasser A AlJoaib; Faisal A AlGhamdi; Annas Ghafoor; Fandi Z AlAnazi; Nisreen H Maghraby

doi:10.4103/jets.jets_124_23

A Systematic Review and Meta-Analysis of Prehospital Plasma Administration for Hemorrhagic Shock

J Emerg Trauma Shock. 2024 Jul-Sep;17(3):136-141. doi: 10.4103/jets.jets_124_23. Epub 2024 Aug 28.

Authors

Nasser A AlJoaib¹, Faisal A AlGhamdi¹, Annas Ghafoor², Fandi Z AlAnazi³, Nisreen H Maghraby⁴

Affiliations

¹ Medical Intern, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
² Medical Intern, College of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
³ Emergency Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
⁴ Emergency Medicine Department, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Dammam, Saudi Arabia.

Abstract

Introduction: Hemorrhagic shock demands swift intervention. Management involves the rapid infusion of blood products to restore circulation and uphold tissue perfusion. The aim of this study was to evaluate the effectiveness of prehospital plasma administration in trauma patients, comparing outcomes with normal saline. This was a meta-analysis of randomized controlled trials.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, searches were conducted in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials from August 1, 2018, to April 4, 2023. The PubMed search string included terms related to blood plasma, prehospital care, emergency medical services, and hemorrhagic shock: (Blood Plasma [MeSH Terms] OR fresh frozen plasma [MeSH Terms] OR plasma OR fresh frozen plasma OR FFP) AND (Prehospital OR emergency care, prehospital [MeSH Terms] OR prehospital emergency care [MeSH Terms] OR prehospital OR prehospital OR EMS OR emergency medical service [MeSH Terms]) AND (hemorrhagic shock [MeSH Terms] OR hemorrhage OR hemorrhage OR hemorrhagic shock OR hemorrhagic shock). Results from the trials were pooled using a random effects model, presented as risk ratios with 95% confidence intervals.

Results: In the analysis of 760 patients from three studies, outcomes included mortality at 24 h and 28 days, multi-organ failure (MOF), acute lung injury, and vasopressor use within 24 h. Patients were divided into plasma (363) and normal saline (397) groups.

Conclusion: There is no distinction between prehospital plasma administration and normal saline concerning mortality at 24 and 28 days or the need for vasopressors within 24 h. Moreover, plasma administration did not appear to influence rates of acute lung injury or MOF.

Keywords: Hemorrhagic shock; plasma; resuscitation; shock.