State of the Evidence for Prehospital Plasma Infusion for Patients With Suspected Traumatic Hemorrhage: A Rapid...

Hemorrhage is the leading cause of preventable early trauma death. Replacement of volume and clotting factors is a critical component to reduce morbidity and mortality. The objective of this rapid systematic review was to evaluate the outcomes related to the administration of plasma in patients with traumatic hemorrhage in a prehospital environment. PubMed was searched for studies reporting plasma administration in prehospital patients with suspected traumatic hemorrhage. We reported each study's demographics, settings, and outcomes using the Prehospital Evidence-Based Practice Level and Direction of Evidence matrix. The search retrieved 1,008 titles, of which 43 articles were included. Most studies were randomized controlled trials or randomized controlled trial reanalyses, and the most common setting was critical care transport (CCT). Prehospital plasma was supported as the primary outcome of mortality in 73% of the studies. A total of 13 adverse events were reported across all studies, and plasma delivery was correlated with hypocalcemia in 1 study. High-quality evidence (Level and Direction of Evidence I) supports the delivery of plasma in the CCT prehospital setting to improvement of 30-day mortality for a range of patient presentations. The addition of plasma as part of a robust trauma resuscitation strategy in the CCT air medical setting is feasible and cost-effective.