Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury
Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury
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DOI：
10.1097/ta.0000000000001581
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发表时间：
2017-09-01
影响因子：
3.4
通讯作者：
Zietlow, Scott P.
中科院分区：
文献类型：
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作者：
Hernandez, Matthew C.;Thiels, Cornelius A.;Zietlow, Scott P.
背景：创伤性脑损伤（TBI）患者的创伤相关性低血压和凝血功能障碍会加重继发性脑损伤。早期使用血液制品进行损伤控制复苏可减轻低血压和凝血功能障碍。初步数据表明，在大型动物中使用血浆复苏可改善TBI后的神经功能;然而，缺乏人类的数据。方法：我们回顾性地确定了2002年1月至2013年12月在一个I级创伤中心接受院前血液制品复苏的年龄> 15岁的多发性损伤头部损伤患者。入选标准为采用浓缩红细胞（pRBC）或解冻血浆作为唯一胶体复苏的院前复苏。排除了在医院死亡的患者和使用抗凝剂的患者。主要结果是格拉斯哥结局评分扩展（GOSE）和残疾评级评分（DRS）在解雇和follow-up.Results：76例符合纳入标准，53%（n = 40）接受院前pRBC和47%（n = 36）接受解冻血浆。年龄、性别、损伤严重程度或TBI严重程度、到达时的实验室检查值和院前单位数量相似（均p > 0.05）。与接受pRBC的患者相比，接受解冻血浆的患者具有改善的神经功能结局（中位GOSE 7 [7-8] vs. 5.5 [3-7]，p < 0.001）。此外，与pRBC相比，接受解冻血浆的患者具有改善的功能性（中值DRS 2 [1-3.5]对9 [3-13]，p < 0.001）。在随访期间（中位6 [5-7]个月）计算的GOSE和DRS评分显示，与pRBC相比，解冻血浆复苏的患者的GOSE和DRS评分均增加，（8 [7-8] vs. 6 [6-7]，p < 0.001）和DRS（0 [0-1] vs. 4 [2-8]，p < 0.001）。在严重创伤的创伤患者中，用解冻血浆早期复苏与出院时和随访期间神经和功能结局的改善相关，与单独的pRBC相比。这些初步的数据支持进一步的调查和使用的血浆在复苏严重受伤的TBI患者。（版权所有（C）2017 Wolters Kluwer Health，Inc.版权所有© 2016
BACKGROUND: Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking.METHODS: We retrospectively identified all patients with multiple injuries age > 15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) 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 prehospital pRBCs and 47%(n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p < 0.001). Additionally, patients who received thawed plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p < 0.001). Calculated GOSE and DRS scores during follow-up, median 6 [5-7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p < 0.001) and DRS (0 [0-1] vs. 4 [2-8], p < 0.001).CONCLUSION: In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. (Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.)