Prehospital plasma transfusion, cost-effective and lifesaving for unstable trauma patients: JAMA

USA: Katherine A. Hrebinko and colleagues demonstrated in this study that prehospital thawed plasma transfusion during air medical evacuation for trauma patients in hemorrhagic shock was lifesaving and cost-effective relative to conventional treatment and should become standard practice. The data and aspects of this study were published in The Journal of the American Medical Association (JAMA) on 22nd September 2021.

Prehospital plasma transfusion can save the lives of trauma patients in hemorrhagic shock, but it is seldom utilized due to cost and practicality problems. The goal of this study was to determine the cost-effectiveness of prehospital thawed plasma transfusion in trauma patients suffering from hemorrhagic shock during air medical evacuation.

Using published and unpublished patient-level data from the Prehospital Plasma in Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock (PAMPer) trial, which ran from May 2014 to October 2017, health care and trauma-specific databases, and the published literature, a decision tree and Markov model were developed to compare standard care and prehospital thawed plasma transfusion. Prehospital transfusion, short-term inpatient treatment, lifelong health care expenditures, and quality of life outcomes were all taken into account. Across clinically reasonable ranges, one-way, two-way, and Monte Carlo probabilistic sensitivity assessments were undertaken and in n December 2019 the data was examined.

Prehospital thawed plasma was more cost-effective than standard care resuscitation in a cost-effectiveness model based on data from a randomized multicenter clinical study, with an added cost-effectiveness ratio of $50 467.44 per quality-adjusted life-year (QALY). Across sensitivity studies, the incremental cost of thawed plasma per QALY remained below the usual $100,000 per QALY barrier.

Finally, the author stated that prehospital thawed plasma might be lifesaving and cost-effective, and that it should become a routine component of resuscitation for trauma patients in hemorrhagic shock during air transport.

Reference:

Hrebinko, K. A., Sperry, J. L., Guyette, F. X., Brown, J. B., Daley, B. J., Miller, R. S., Harbrecht, B. G., Claridge, J. A., Phelan, H. A., Neal, M. D., Zuckerbraun, B. S., Yazer, M. H., & Nicholson, K. J. (2021). Evaluating the Cost-effectiveness of Prehospital Plasma Transfusion in Unstable Trauma Patients. JAMA Surgery. https://doi.org/10.1001/jamasurg.2021.4529