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Prehospital Plasma Transfusion Lifesaving, Cost-Effective During In-Flight Trauma Care

NEW YORK (Reuters Health) – Among trauma patients with hemorrhagic shock, the use of prehospital thawed-plasma transfusion during air medical transport is cost-effective and associated with better survival than standard resuscitation, according to new findings.

Hemorrhage is the most common preventable cause of trauma-related mortality in the U.S., and prehospital plasma transfusion is known to be lifesaving for trauma patients in hemorrhagic shock, researchers note in JAMA Surgery. But due to “cost and feasibility concerns,” the intervention is not commonly used.

To investigate, Dr. Jason Sperry of the University of Pittsburgh Medical Center and colleagues analyzed data from the 501 participants in the PAMPer study, a pragmatic, multicenter, cluster-randomized, phase-3 trial that found that using thawed plasma lowered mortality compared with standard-care resuscitation during air medical transport (https://bit.ly/3oAji1M).

The trial was done between 2014 and 2017. Average daily costs associated with hospitalization after traumatic injury were estimated using data from the Healthcare Cost and Utilization Project as well as the published literature.

Compared with standard of care, thawed-plasma transfusion had an incremental cost-effectiveness ratio of $50,467 per quality-adjusted life-year (QALY), below the willingness-to-pay threshold of $100,000 per QALY.

In a subgroup analysis of patients who experienced injury by a blunt mechanism, the incremental cost-effectiveness ratio dropped to $37,735 per QALY. The difference was largely attributable to in-hospital and post-discharge lifetime care of patients who were critically ill and survived severe trauma.

Sensitivity analyses also favored the use of thawed plasma. On probabilistic sensitivity analysis, thawed plasma was preferred in 81% of the 10,000 iterations.

While level-1 evidence demonstrated a survival benefit with prehospital thawed plasma, the researchers note that the “incorporation of this strategy into resuscitation algorithms during air transport has been limited, likely because of concerns regarding the economic and logistical burden of supporting these programs.”

However, in a linked commentary on the study, Dr. Elliott Haut of The Johns Hopkins University School of Medicine, in Baltimore, Maryland, and colleagues noted that several aeromedical programs in the U.S. have “been using plasma for over a decade without notable waste or increased costs.”

In an email to Reuters Health, Dr. Haut noted that the expansion of thawed-plasma transfusion from research to daily practice will likely be slow, since “it takes 17 years from the publication of a randomized trial for that practice to get into routine use.”

“One of the biggest barriers to date about why this isn’t implemented has been the cost and feasibility of doing this,” added Dr. Haut. “Hopefully their new cost-effectiveness paper will help convince more helicopter systems to stock and use plasma in severely injured trauma patients.”

Dr. Sperry was not available for comment.

SOURCE: https://bit.ly/3A8VVP9 and https://bit.ly/3ounHU7 JAMA Surgery, online September 22, 2021.

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