Shock. 2014 Feb 3. [Epub ahead of print]
- 11:Blood Bank, Haukeland University Hospital, and Institute of Clinical Science, University of Bergen, Norway; 2: NHS Blood and Transplant, Birmingham UK; 3: Division of Transfusion Medicine, Pathology and Oncology, Johns Hopkins, Baltimore, MD USA; 4: Military Blood Bank, Central Military Hospital, Ministry of Defense, The Netherlands; 5: Department of Transfusion Medicine, Örebro University Hospital, Sweden; 6: The Trauma and Combat Medicine Branch Medical Corps, Surgeon General´s Headquarters, Israel Defence Force; 7: Norwegian Defence Medical Service, Department of Medicine, and Department of Immunology and Transfusion medicine, Oslo University Hospital, Norway.
Abstract
SUMMARY:
At the 2013 Traumatic Hemostasis and Oxygenation Research (THOR) Network's Remote Damage Control Resuscitation (R-DCR) symposium, a panel of senior blood bankers with both civilian and military background, were invited to discuss their willingness and ability to supply pre-hospital plasma for resuscitation of massively bleeding casualties, and to comment on the optimal preparations for such situations. Available evidence indicates that pre-hospital use of plasma may improve R-DCR, although level 1 evidence is lacking. This practice is well established in several military services, and is also being introduced in civilian settings. There are few, if any, clinical contraindications to the pre-hospital use of plasma, except for blood group incompatibility and the danger of TRALI, which can be circumvented in various ways. However, the choice of plasma source, plasma preparation, and logistics including stock management require consideration. Staff training should include haemovigilance and traceability as well as recognition and management of eventual side effects. Pre-hospital use of plasma should occur within the framework of clinical algorithms and prospective clinical studies. Clinicians have an ethical responsibility to both patients and donors; therefore the introduction of new clinical capabilities of transfusion must be safe, efficacious and sustainable. The panel agreed that although these problems need further attention and scientific studies, now is the time for both military and civilian transfusion systems to prepare for pre-hospital use of plasma in massively bleeding casualties.
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