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Clinical Trial
. 2020 Dec;89(6):1061-1067.
doi: 10.1097/TA.0000000000002903.

Group A emergency-release plasma in trauma patients requiring massive transfusion

Amory de Roulet  1 , Jeffrey D Kerby, Jordan A Weinberg, Richard H Lewis Jr, Jay P Hudgins, Ira A Shulman, Erin E Fox, John B Holcomb, Karen J Brasel, Eileen M Bulger, Mitchell Jay Cohen, Bryan A Cotton, Timothy C Fabian, Terence O'Keeffe, Sandro Rizoli, Thomas M Scalea, Martin A Schreiber, Kenji Inaba; PROPPR Study Group
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Clinical Trial

Group A emergency-release plasma in trauma patients requiring massive transfusion

Amory de Roulet et al. J Trauma Acute Care Surg. 2020 Dec.

Abstract

Background: Both groups A and AB plasma have been approved for emergency-release transfusion in acutely bleeding trauma patients before blood grouping being performed. The safety profile associated with this practice has not been well characterized, particularly in patients requiring massive transfusion.

Methods: This secondary analysis of the Pragmatic, Randomized, Optimal Platelet and Plasma Ratios trial examined whether exposure to group A emergency-release plasma (ERP) was noninferior to group AB ERP. We also examined patients whose blood groups were compatible with group A ERP versus patients whose blood groups were incompatible with group A ERP. Outcomes included 30-day mortality and complication rates including systemic inflammatory response syndrome, infection, renal injury, pulmonary dysfunction, and thromboembolism.

Results: Of the 680 patients predicted to receive a massive transfusion, 584 (85.9%) received at least 1 U of ERP. Of the 584 patients analyzed, 462 (79.1%) received group AB and 122 (20.9%) received group A ERP. Using a hazard ratio (HR) of 1.35 as the noninferiority margin, transfusion with group A versus group AB ERP was not associated with increased thromboembolic rates (HR, 0.52; 95% confidence interval [CI], 0.31-0.90). Mortality (HR, 1.15; 95% CI, 0.91-1.45) and nonfatal complication rates (HR, 1.24; 95% CI, 0.87-1.77) were inconclusive. In the subgroup analysis, transfusion with incompatible ERP (group B or AB patients receiving group A ERP) was not associated with increased nonfatal complications (HR, 1.02; 95% CI, 0.80-1.30). There were no reported hemolytic transfusion reactions.

Conclusion: The use of ERP is common in patients requiring massive transfusion and facilitates the rapid balanced resuscitation of patients who have sustained blood loss. Group A ERP is an acceptable option for patients requiring massive transfusion, especially if group AB ERP is not readily available.

Level of evidence: Therapeutic/Care Management, level IV; Prognostic, level III.

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Figures

Figure 1.
Figure 1.
Association between receiving group A versus group AB emergency release plasma and time to death or various complications among trauma patients requiring massive transfusion protocol. HR, Hazard ratio; CI, confidence interval; SIRS, systemic inflammatory response syndrome; renal: acute kidney injury and acute renal failure; pulmonary: acute respiratory distress syndrome and acute lung injury. Covariates in adjusted model included: age, first systolic blood pressure, GCS <9, number of units of ERP transfused, 3 hour red blood cell (RBC) transfusion, and 3 hour crystalloid infusion.
Figure 2.
Figure 2.
Association between receiving compatible (recipient group A or O) versus incompatible (recipient group B or AB) emergency release group A plasma and time to death or various complications among trauma patients requiring massive transfusion protocol. HR, Hazard ratio; CI, confidence interval; SIRS, systemic inflammatory response syndrome; renal: acute kidney injury and acute renal failure, pulmonary: acute respiratory distress syndrome and acute lung injury. Covariates in adjusted model included: age, first systolic blood pressure, GCS <9, number of units of ERP transfused, 3 hour red blood cell (RBC) transfusion, and 3 hour crystalloid infusion.
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References

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