Liquid plasma: A solution to optimizing early and balanced plasma resuscitation in massive transfusion

Area of Science:

• Trauma Resuscitation
• Hemorrhagic Shock Management
• Blood Product Transfusion

Background:

• Early and balanced resuscitation is critical for reducing mortality in traumatic hemorrhagic shock.
• Fresh frozen plasma (FFP) administration is often delayed by thawing times, impacting timely resuscitation.
• Liquid plasma (LP) offers immediate transfusion availability and extended shelf life, addressing FFP limitations.

Purpose of the Study:

• To evaluate the impact of liquid plasma (LP) implementation in massive transfusion protocols (MTPs) on resuscitation efficiency and patient outcomes.
• To compare plasma/red blood cell (RBC) ratios and initial plasma transfusion times before and after LP adoption.
• To assess the effect of LP on mortality, 28-day recovery, and complication rates in severely injured patients.

Main Methods:

• Retrospective analysis of MTP activations from trauma quality improvement program data (2016-2018).
• Comparison of resuscitation metrics (plasma/RBC ratios, transfusion times) pre-LP (FFP only) and post-LP implementation.
• Statistical analysis using linear regression and Cox proportional hazards regression to evaluate outcomes.

Main Results:

• Post-LP implementation showed improved time to initial plasma transfusion and plasma/RBC ratios at 4 and 24 hours.
• A significant reduction in RBC units transfused was observed after LP adoption (p < 0.05).
• LP was associated with improved 28-day recovery (HR, 3.16) and reduced acute kidney injury (HR, 0.092).

Conclusions:

• Liquid plasma (LP) optimizes early plasma administration and adherence to transfusion guidelines in massive transfusion protocols.
• LP offers a viable alternative to FFP, mitigating delays and improving clinical outcomes, including recovery and reduced acute kidney injury.
• Consideration of LP as a standard alternative to FFP in MTPs is recommended for improved trauma care.