Giving plasma in helicopters, before hospital, may save trauma patients

Giving plasma to trauma victims during air transport, rather than waiting until arrival at the hospital, saved lives, according to the results of a study that involved patients treated aboard MetroHealth Medical Center’s Life Flight helicopters.

MetroHealth, with Case Western Reserve University, was one of six nationwide locations to receive Department of Defense funding for the trial, which launched in 2014.

The study results were published recently in the New England Journal of Medicine and showed a 39 percent lower risk of death within 30 days for those who received plasma in flight compared to those who received standard care.

Trauma patients routinely receive plasma, which is a component of whole blood that aids clotting, when they get to the hospital. Plasma is not routinely given in flight because it is stored frozen and once thawed has to remain cooled and be used within a matter of days. Most helicopters do not have coolers. Typical care for trauma patients in-flight includes fluids such as saline and sometimes red blood cells.

“We’re excited that the results showed that we have a treatment we can offer our patients that reduces mortality,” and is safe, said Dr. Jeffrey Claridge, director of trauma, critical care and burns at MetroHealth.

MetroHealth is preparing to offer plasma in-flight on all its helicopters, Claridge said. It is unclear exactly how much it will cost to outfit the helicopters and routinely stock fresh plasma, but Claridge said the study’s results justify the investment.

The hospital system is looking into techniques that would allow doctors to use the plasma longer than the standard five days after it has thawed. That would make providing the blood product aboard helicopters less expensive and less labor-intensive.

The trial, called the Prehospital Air Medical Plasma trial, or “PAMPer,” trial, equipped helicopters with coolers that allow plasma to be delivered in-flight. About 500 trauma victims nationwide, including 52 in the Cleveland area, participated in the study, with about half given plasma in flight and the rest given standard care.

Participants in the trial included victims of severe trauma, such as gunshots, falls from a height, car accidents or stabbings. Because patients were likely to be in shock or unconscious, consent was assumed under the Food and Drug Administration’s “exception from informed consent requirements for emergency research.” Patients who may not have wanted to participate, including those who do not believe in accepting blood products, were allowed to request a wrist ID bracelet from study coordinators before the trial began.

Nobody enrolled in the trial in Cleveland complained about being included in the study, Claridge said.

The trial showed that giving plasma more quickly increased a patient’s likelihood of survival: the risk of death at 30 days after injury was 23 percent for the in-flight plasma group versus 33 percent for the standard care group.

The intervention did not significantly affect several other factors the group studied, including total blood transfusion requirements during the first 24 hours, or whether a patient developed multiple organ failure, hospital-acquired infection, acute lung injury (ALI) or transfusion-related acute lung injury (TRALI).