Prehospital Plasma Resuscitation Associated With Improved Neurologic Outcomes After Traumatic Brain Injury.

Introduction: Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. Methods: We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBC) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow up. Results: Of 76 patients meeting inclusion criteria 53% (n=40) received pre-hospital pRBC and 47% (n=36) received thawed plasma. Age, gender, injury severity (ISS) or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p>0.05). Patients that received thawed plasma had an improved neurologic outcome compared to those receiving pRBC (median GOSE 7 [7-8] vs 5.5 [3-7], p

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