Pre-hospital plasma in haemorrhagic shock management: current opinion and meta-analysis of randomized trials.
Haemorrhagic
Management
Meta-analysis
Pre-hospital
Shock
Trauma
Treatment
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
Historique:
received:
10
10
2018
accepted:
07
02
2019
entrez:
1
3
2019
pubmed:
1
3
2019
medline:
14
6
2019
Statut:
epublish
Résumé
Trauma-induced coagulopathy is one of the most difficult issues to manage in severely injured patients. The plasma efficacy in treating haemorrhagic-shocked patients is well known. The debated issue is the timing at which it should be administered. Few evidences exist regarding the effects on mortality consequent to the use of plasma alone given in pre-hospital setting. Recently, two randomized trials reported interesting and discordant results. The present paper aims to analyse data from those two randomized trials in order to obtain more univocal results. A systematic review with meta-analysis of randomized controlled trials (RCTs) of pre-hospital plasma vs. usual care in patients with haemorrhagic shock. Two high-quality RCTs have been included with 626 patients (295 in plasma and 331 in usual care arm). Twenty-four-hour mortality seems to be reduced in pre-hospital plasma group (RR = 0.69; 95% CI = 0.48-0.99). Pre-hospital plasma has no significant effect on 1-month mortality (RR = 0.86; 95% CI = 0.68-1.11) as on acute lung injury and on multi-organ failure rates (OR = 1.03; 95% CI = 0.71-1.50, and OR = 1.30; 95% CI = 0.92-1.86, respectively). Pre-hospital plasma infusion seems to reduce 24-h mortality in haemorrhagic shock patients. It does not seem to influence 1-month mortality, acute lung injury and multi-organ failure rates.
Sections du résumé
BACKGROUND
BACKGROUND
Trauma-induced coagulopathy is one of the most difficult issues to manage in severely injured patients. The plasma efficacy in treating haemorrhagic-shocked patients is well known. The debated issue is the timing at which it should be administered. Few evidences exist regarding the effects on mortality consequent to the use of plasma alone given in pre-hospital setting. Recently, two randomized trials reported interesting and discordant results. The present paper aims to analyse data from those two randomized trials in order to obtain more univocal results.
METHODS
METHODS
A systematic review with meta-analysis of randomized controlled trials (RCTs) of pre-hospital plasma vs. usual care in patients with haemorrhagic shock.
RESULTS
RESULTS
Two high-quality RCTs have been included with 626 patients (295 in plasma and 331 in usual care arm). Twenty-four-hour mortality seems to be reduced in pre-hospital plasma group (RR = 0.69; 95% CI = 0.48-0.99). Pre-hospital plasma has no significant effect on 1-month mortality (RR = 0.86; 95% CI = 0.68-1.11) as on acute lung injury and on multi-organ failure rates (OR = 1.03; 95% CI = 0.71-1.50, and OR = 1.30; 95% CI = 0.92-1.86, respectively).
CONCLUSIONS
CONCLUSIONS
Pre-hospital plasma infusion seems to reduce 24-h mortality in haemorrhagic shock patients. It does not seem to influence 1-month mortality, acute lung injury and multi-organ failure rates.
Identifiants
pubmed: 30815028
doi: 10.1186/s13017-019-0226-5
pii: 226
pmc: PMC6377767
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
6Déclaration de conflit d'intérêts
Not applicableNot applicableThe authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Références
J Trauma. 2007 Jan;62(1):112-9
pubmed: 17215741
J Trauma. 2007 Feb;62(2):307-10
pubmed: 17297317
J Trauma. 2008 Aug;65(2):261-70; discussion 270-1
pubmed: 18695460
J Trauma. 2008 Nov;65(5):986-93
pubmed: 19001962
J Trauma. 2009 Feb;66(2):358-62; discussion 362-4
pubmed: 19204508
Ann Surg. 2011 Oct;254(4):598-605
pubmed: 21918426
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
Injury. 2013 May;44(5):611-7
pubmed: 22377276
J Trauma Acute Care Surg. 2012 Aug;73(2):358-64; discussion 364
pubmed: 22846940
JAMA Surg. 2013 Feb;148(2):127-36
pubmed: 23560283
Crit Care. 2013 Apr 19;17(2):R76
pubmed: 23601765
Cochrane Database Syst Rev. 2013 Aug 12;(8):CD007088
pubmed: 23939652
Shock. 2014 May;41 Suppl 1:35-8
pubmed: 24317352
JAMA. 2015 Feb 3;313(5):471-82
pubmed: 25647203
Shock. 2016 Jul;46(1):3-16
pubmed: 26825635
Scand J Trauma Resusc Emerg Med. 2016 Dec 9;24(1):145
pubmed: 27938373
Shock. 2018 Apr;49(4):420-428
pubmed: 28945676
PLoS One. 2017 Dec 19;12(12):e0189870
pubmed: 29261771
Lancet. 2018 Jul 28;392(10144):283-291
pubmed: 30032977
N Engl J Med. 2018 Jul 26;379(4):315-326
pubmed: 30044935
Stat Med. 1987 Apr-May;6(3):341-50
pubmed: 3616287
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
J Trauma. 1997 May;42(5):857-61; discussion 861-2
pubmed: 9191667
J Trauma. 1998 Sep;45(3):545-9
pubmed: 9751548