On the Frontlines of Pre-Hospital Care: The Efficacy of Freeze-Dried Plasma

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Despite continued developments made in the field of trauma care, hemorrhagic shock resulting from trauma remains the leading cause of preventable death on the battlefield. The current methods being used for the treatment of patients with acute hemorrhage include dressing the wound in an attempt to stop the bleeding, along with intravenous administration of fluids intended to replace the blood loss and treat the accompanying shock. The question of what kind of fluid to use is one that fascinated many throughout history, consequentially leading to the development of physiological crystalloid based solutions on one hand and isolated blood products on the other. With its introduction, plasma was found to have significant clinical benefits, conceivably because plasma replenishes various coagulation proteins that are consumed during the coagulopathy that often accompanies traumatic injuries. In military and remote settings, the logistical limitations of plasma, namely the need to maintain a comprehensive cold-chain infrastructure and the complicated process of thawing the plasma, restricted the use of plasma in these settings. In World War II, these barriers were lifted as Freeze-Dried Plasma (FDP) was invented, not requiring any freezers and soon available. This product was vastly used during the war with hundreds of thousands treated, but then disremembered because of disease transmission issues such as hepatitis found among recipients in the 1960’s. Modern-day advanced techniques have improved the safety and made it possible to produce safe and effective dried plasma solving the previous problems, but still, FDP is currently used by only a few countries worldwide. In line with its unpopularity, little has been published regarding the clinical effects of this product. Purpose of this Study: To shed light on the clinical effectiveness of using freeze-dried plasma as a pre-hospital resuscitation fluid during the treatment of hemorrhagic shock in the pre-hospital setting. Methods: A retrospective analysis of data collected on trauma patients injured in the Syrian civil war and treated by the IDF from 2014 until 2016. Casualties who required long evacuation time (i.e., over 45 minutes) were chosen. Two groups of casualties were allocated according to weather FDP was used (N=29), or standard-care fluids were given (N=83). Results: Using FDP as part of the pre-hospital resuscitation was shown to be associated with an improvement in both vital signs and shock index score. Moreover, among these patients, a lower transfusion volume was needed throughout their hospitalization. However, an increased risk for mortality, increased risk of in-hospital blood transfusion, and increased risk of pre-hospital intubation were observed in the FDP treated group. Conclusions: The effectiveness of FDP presented inconclusive but promising results in lowering the severity of shock and reducing iatrogenic coagulopathy in trauma patients. Further research is needed to disprove the adverse outcomes of this study.