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Helicopter In-flight Resuscitation with Freeze-dried Plasma of a Patient with a High-velocity Gunshot Wound to the Neck in Afghanistan – A Case Report

Published online by Cambridge University Press:  01 September 2015

Mikael Gellerfors*
Affiliation:
Karolinska Institutet/Södersjukhuset, Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Stockholm, Sweden SAE Medevac Helicopter, Armed Forces Centre for Defense Medicine (FörmedC), Gothenburg, Sweden
Joacim Linde
Affiliation:
SAE Medevac Helicopter, Armed Forces Centre for Defense Medicine (FörmedC), Gothenburg, Sweden Ambulance Helicopter VGR, Säve, Sweden
Dan Gryth
Affiliation:
Karolinska Institutet, Department of Physiology, Section of Anesthesiology and Intensive Care, Stockholm, Sweden
*
Correspondence: Mikael Gellerfors, MD Karolinska Institutet/Södersjukhuset Department of Clinical Science and Education Section of Anesthesiology and Intensive Care Sjukhusbacken 10 118 83 Stockholm, Sweden E-mail: mikael.gellerfors@ki.se

Abstract

Massive hemorrhage with coagulopathy is one of the leading causes of preventable death in the battlefield. The development of freeze-dried plasma (FDP) allows for early treatment with coagulation-optimizing resuscitation fluid in the prehospital setting. This report describes the first prehospital use of FDP in a patient with carotid artery injury due to a high-velocity gunshot wound (HVGSW) to the neck. It also describes in-flight constitution and administration of FDP in a Medevac Helicopter. Early administration of FDP may contribute to hemodynamic stabilization and reduction in trauma-induced coagulopathy and acidosis. However, large-scale studies are needed to define the prehospital use of FDP and other blood products.

Gellerfors M, Linde J, Gryth D. Helicopter In-flight Resuscitation with Freeze-dried Plasma of a Patient with a High-velocity Gunshot Wound to the Neck in Afghanistan – A Case Report. Prehosp Disaster Med. 2015;30(5):509–511.

Type
Case Report
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. Spinella, PC, Holcomb, JB. Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev. 2009;23(6):231-240.Google Scholar
2. Katzenell, U, Ash, N, Tapia, AL, Campino, GA, Glassberg, E. Analysis of the causes of death of casualties in the field military setting. Mil Med. 2012;177(9):1065-1068.Google Scholar
3. Maegele, M, Spinella, PC, Schochl, H. The acute coagulopathy of trauma: mechanisms and tools for risk stratification. Shock. 2012;38(5):450-458.Google Scholar
4. Borgman, MA, Spinella, PC, Perkins, JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805-813.Google Scholar
5. Holcomb, JB, Wade, CE, Michalek, JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248(3):447-458.CrossRefGoogle ScholarPubMed
6. Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(Suppl 5):S431-S437.CrossRefGoogle ScholarPubMed
7. Holcomb, JB, del Junco, DJ, Fox, EE, et al. The Prospective, Observational, Multicentre, Major Trauma Transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127-136.Google Scholar
8. de Biasi, AR, Stansbury, LG, Dutton, RP, Stein, DM, Scalea, TM, Hess, JR. Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME). Transfusion. 2011;51(9):1925-1932.CrossRefGoogle ScholarPubMed
9. Gonzalez, EA, Moore, FA, Holcomb, JB, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. 2007;62(1):112-119.Google Scholar
10. Pidcoke, HF, Aden, JK, Mora, AG, et al. Ten-year analysis of transfusion in Operation Iraqi Freedom and Operation Enduring Freedom: increased plasma and platelet use correlates with improved survival. J Trauma Acute Care Surg. 2012;73(Suppl 5):S445S452.Google Scholar
11. Brohi, K, Singh, J, Heron, M, Coats, T. Acute traumatic coagulopathy. J Trauma. 2003;54(6):1127-1130.CrossRefGoogle ScholarPubMed
12. MacLeod, JB, Lynn, M, McKenney, MG, Cohn, SM, Murtha, M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55(1):39-44.Google Scholar
13. Niles, SE, McLaughlin, DF, Perkins, JG, et al. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma. 2008;64(6):1459-1463.Google ScholarPubMed
14. Alam, HB, Bice, LM, Butt, MU, et al. Testing of blood products in a polytrauma model: results of a multi-institutional randomized preclinical trial. J Trauma. 2009;67(4):856-864.Google Scholar
15. Sondeen, JL, Prince, MD, Kheirabadi, BS, et al. Initial resuscitation with plasma and other blood components reduced bleeding compared to hetastarch in anesthetized swine with uncontrolled splenic hemorrhage. Transfusion. 2011;51(4):779-792.Google Scholar
16. Pennardt, A. The time to field freeze dried plasma is now. J Spec Oper Med. 2010;10(3):49.Google Scholar
17. German Red Cross. Summary of Product Characteristics LyoPlas N-w. German Red Cross Web site. www.blutspendedienst-west.de. Accessed March 1, 2015.Google Scholar
18. Bux, J, Dickhorner, D, Scheel, E. Quality of freeze-dried (lyophilized) quarantined single-donor plasma. Transfusion. 2013;53(12):3203-3209.Google Scholar
19. Martinaud, C, Ausset, S, Deshayes, AV, Cauet, A, Demazeau, N, Sailliol, A. Use of freeze-dried plasma in French intensive care unit in Afghanistan. J Trauma. 2011;71(6):1761-1764; discussion 1764-1765.Google Scholar
20. Glassberg, E, Nadler, R, Gendler, S, et al. Freeze-dried plasma at the point of injury: from concept to doctrine. Shock. 2013;40(6):444-450.Google Scholar
21. Glassberg, E, Nadler, R, Rassmussen, TE, et al. Point-of-injury use of reconstituted freeze dried plasma as a resuscitative fluid: a special report for prehospital trauma care. J Trauma Acute Care Surg. 2013;75(Suppl 2):S111-S114.Google Scholar
22. Jernling, C, Linde, J, Gryth, D. Frystorkad plasma bör användas civilt i Sverige. Läkartidningen. 2014;111(24):1069.Google Scholar