The Impact of Pre Hospital Administration of Freeze Dried Plasma on Casualty Outcome

Background Hemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty’s remaining factors. The Israel Defense Force Medical Corps decided to use Freeze dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting. The Aim of our study is to compare the differences of coagulation, perfusion measurements, resource utilization, and outcome between casualties receiving FDP to casualties who didn’t receive FDP in the prehospital setting. Methods This is a retrospective matched cohort study based on two groups of casualties (those treated with FDP vs. those without FDP treatment). The control group was compiled in three steps of precision for age, gender, mechanism of injury and maximum level of severity for each nine injured body regions. Data were collected from the IDF Trauma Registry and The National Israel Trauma Registry. Results The study group comprised 48 casualties receiving FDP and 48 controls with no differences in demographic, evacuation time and injury characteristics. The FDP group demonstrated a lower level of hemoglobin (12.7 gr/dzl) (OR 3.11 95%CI 1.10-8.80), lower level of INR (1.1) (OR 3.09 95%CI 1.04-9.14) and lower level of platelets (230x109/L) (OR 3.06 95%CI 1.16-8.06). No other differences were found between the two groups. Conclusion The use of FDP in the prehospital setting has logistic benefits and a positive effect on coagulation profile, with no other significant effectsn. Future studies need to be done on larger groups in order to verify trends or nullify our hypotheses. Level of Evidence IV Study type retrospective matched cohort study Israel Trauma Group (ITG) includes: Alfici R, Bahouth H, Becker A, Jeroukhimov I, Karawani I, Kessel B, Klein Y, Lin G, Merin O, Miklosh B, Mnouskin Y, Rivkind A, Shaked G, Sivak G, Soffer D, Stein M, and Weiss M. Equally contributing first author, Shlaifer Amir MD, Siman-Tov Maya PhD Corresponding Author's contact information: Amir Shlaifer MD, MHA, Address: Surgeon General’s Headquarters, Military POB 02149, Israel Defense Forces, 02149, Israel, Telephone Numbers: Mobile - (+) 972-52-7360803, Office - (+)972-3-5401150, Email: shlaifer.md@gmail.com Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Conference Presentation: None Conflict of interest: The authors declare no conflict of interest. Disclosures of funding received for this work: Research reported in this publication was supported by the Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research & Development, Israeli Ministry of Defense (IMOD DDR&D) © 2018 Lippincott Williams & Wilkins, Inc.

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