Early resuscitation with lyophilized plasma provides equal neuroprotection compared to fresh frozen plasma in a large animal survival model of traumatic brain injury and hemorrhagic shock.

Background: Combined traumatic Brain Injury (TBI) and hemorrhagic shock (HS) is highly lethal. In previous models of combined TBI+HS, we showed that early resuscitation with fresh frozen plasma (FFP) improves neurological outcomes. Delivering FFP, however, in austere environments is difficult. Lyophilized plasma (LP) is a logistically superior alternative to FFP but data is limited regarding its efficacy for treatment of TBI. We conducted this study to determine the safety and long-term outcomes of early treatment with LP in a large animal model of TBI+HS. Methods: Adult anesthetized swine underwent TBI and volume-controlled hemorrhage (40% blood volume) concurrently. After 2 h of shock, animals were randomized (n=5/group) to FFP or LP (1x shed blood) treatment. Serial blood gases were drawn and thrombelastography (TEG) was performed on citrated, kaolin-activated whole blood samples. Five hours post-treatment, packed red blood cells were administered, and animals recovered. A 32-point neurologic severity score was assessed daily for 30 days (0 = normal, 32 = most severe injury). Cognitive functions were tested by training animals to retrieve food from color-coded boxes. Brain lesion size was measured on serial magnatic resonance imaging, and an autopsy was performed at 30 days. Results: The severity of shock and the degree of resuscitation were similar in both groups. Administration of FFP and LP was well tolerated with no differences in reversal of shock, or TEG parameters. Animals in both groups displayed the worst NSS on POD 1 with rapid recovery and return to baseline within 7 days of injury. Lesion size on day 3 in FFP treated animals was 645 +/- 85 vs. 219 +/- 20 mm3 in LP treated animals (p

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