Making thawed universal donor plasma available rapidly for massively bleeding trauma patients

Experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial

PROPPR Study Group

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

BACKGROUND: The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS: At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines. RESULTS: Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared. CONCLUSION: Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.

Original languageEnglish (US)
Pages (from-to)1331-1339
Number of pages9
JournalTransfusion
Volume55
Issue number6
DOIs
StatePublished - Jun 1 2015

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Blood Platelets
Tissue Donors
Hemorrhage
Wounds and Injuries
Trauma Centers
Resuscitation
Guidelines
Blood Group Antigens
Quality Improvement
Emergencies
Randomized Controlled Trials
Erythrocytes
Survival

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

@article{29a8c4b919c34c5da45e8fbeb7f67678,
title = "Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: Experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial",
abstract = "BACKGROUND: The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS: At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines. RESULTS: Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25{\%} of AB plasma prepared. CONCLUSION: Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.",
author = "{PROPPR Study Group} and Novak, {Deborah J.} and Yu Bai and Cooke, {Rhonda K.} and Marques, {Marisa B.} and Fontaine, {Magali J.} and Gottschall, {Jerome L.} and Carey, {Patricia M.} and Scanlan, {Richard (Mick)} and Fiebig, {Eberhard W.} and Shulman, {Ira A.} and Nelson, {Janice M.} and Sherri Flax and Veda Duncan and Daniel-Johnson, {Jennifer A.} and Callum, {Jeannie L.} and Holcomb, {John B.} and Fox, {Erin E.} and Sarah Baraniuk and Tilley, {Barbara C.} and Martin Schreiber and Kenji Inaba and Sandro Rizoli and Podbielski, {Jeanette M.} and Cotton, {Bryan A.} and Hess, {John R.}",
year = "2015",
month = "6",
day = "1",
doi = "10.1111/trf.13098",
language = "English (US)",
volume = "55",
pages = "1331--1339",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Making thawed universal donor plasma available rapidly for massively bleeding trauma patients

T2 - Experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial

AU - PROPPR Study Group

AU - Novak, Deborah J.

AU - Bai, Yu

AU - Cooke, Rhonda K.

AU - Marques, Marisa B.

AU - Fontaine, Magali J.

AU - Gottschall, Jerome L.

AU - Carey, Patricia M.

AU - Scanlan, Richard (Mick)

AU - Fiebig, Eberhard W.

AU - Shulman, Ira A.

AU - Nelson, Janice M.

AU - Flax, Sherri

AU - Duncan, Veda

AU - Daniel-Johnson, Jennifer A.

AU - Callum, Jeannie L.

AU - Holcomb, John B.

AU - Fox, Erin E.

AU - Baraniuk, Sarah

AU - Tilley, Barbara C.

AU - Schreiber, Martin

AU - Inaba, Kenji

AU - Rizoli, Sandro

AU - Podbielski, Jeanette M.

AU - Cotton, Bryan A.

AU - Hess, John R.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - BACKGROUND: The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS: At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines. RESULTS: Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared. CONCLUSION: Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.

AB - BACKGROUND: The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS: At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines. RESULTS: Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared. CONCLUSION: Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.

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U2 - 10.1111/trf.13098

DO - 10.1111/trf.13098

M3 - Article

VL - 55

SP - 1331

EP - 1339

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 6

ER -