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Meta-Analysis
. 2019 Feb 15:14:6.
doi: 10.1186/s13017-019-0226-5. eCollection 2019.

Pre-hospital plasma in haemorrhagic shock management: current opinion and meta-analysis of randomized trials

Federico Coccolini  1 , Giacinto Pizzilli  2 , Davide Corbella  3 , Massimo Sartelli  4 , Vanni Agnoletti  2 , Vanessa Agostini  5 , Gian Luca Baiocchi  6 , Luca Ansaloni  1 , Fausto Catena  7
Affiliations
Meta-Analysis

Pre-hospital plasma in haemorrhagic shock management: current opinion and meta-analysis of randomized trials

Federico Coccolini et al. World J Emerg Surg. .

Abstract

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: A systematic review with meta-analysis of randomized controlled trials (RCTs) of pre-hospital plasma vs. usual care in patients with haemorrhagic shock.

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: 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.Level of evidence: Level IStudy type: Systematic review with Meta-analysis.

Keywords: Haemorrhagic; Management; Meta-analysis; Pre-hospital; Shock; Trauma; Treatment.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Mortality outcomes: 24-h mortality (a), 1-month mortality (b)
Fig. 3
Fig. 3
Morbidity outcomes: acute lung injury (a), multi-organ failure (b)
Fig. 4
Fig. 4
Trial sequential analysis: 24-h mortality (a), 1-month mortality (b). [How to read the figure: In blue is the cumulative Z-curves calculated after including subsequent trial into the meta-analysis. A reference line at two-sided Z = 1.96 (equal to a p = .05) is drawn, and it is usually considered the significant result threshold in meta-analysis. Trial sequential monitoring boundaries are reported in red. To obtain reliable evidence (pros or cons of the intervention), the cumulative Z-score must cross the red line. The futility area is dyed in green. If the cumulative Z-score hit the futility area, the result of the meta-analysis is for no effect (neither negative nor positive) of the intervention. On the far right of the figure is the line with the sample size calculation according to the trial sequence analysis methodology]
See this image and copyright information in PMC

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