Why isn't blood plasma used in pre-hospital in the US anymore?

[TimRaven]

This question has been in my mind for awhile, and I couldn't find answer in my textbook or online.

Why did we stop giving blood plasma to trauma patients in the pre-hospital in the US after Vietnam war?
Isn't plasma supposedly helping clotting process and fighting infection? I know it is still used by the military, and by other countries till this day, often in dehydrated powder form.

 

[SpecialK]

Plasma is simply one part of blood. In most major trauma the tendency has been to use 1:1:1 ratio of plasma (as FFP), platelets and red cells, however as I understand, this has evolved somewhat to just giving whole blood

Whole blood is being given in the prehospital phase in a number of places around the world. I do not think it will ever be a routine thing carried on every ambulance unless some sort of man-made blood can be invented.

 

[TransportJockey]

Plasma is simply one part of blood. In most major trauma the tendency has been to use 1:1:1 ratio of plasma (as FFP), platelets and red cells, however as I understand, this has evolved somewhat to just giving whole blood

Whole blood is being given in the prehospital phase in a number of places around the world. I do not think it will ever be a routine thing carried on every ambulance unless some sort of man-made blood can be invented.

The few areas that carry blood products carry ffp or prbc. I know of no prehospital agencies carrying whole blood. Although that would be the best.thing to carry

 

[Carlos Danger]

Im not aware of plasma ever being used in American EMS.

And if it was, I think a better question would be "why was blood plasma ever used in pre-hospital in the US"?

 

[Handsome Robb]

Having blood products on every ambulance would be awesome. However it would be a logistical nightmare with massive amounts of wasted blood when there's continuous shortages for hospitals themselves.


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[TimRaven]

From what I read in pre-1980 military medicine manuals, it was common practice to give reconstitute blood plasma to trauma patients to improve their clotting factors, a few civilians services also have similar practice.

The practice is still used today in the military:
http://www.militaryblood.dod.mil/viewcontent.aspx?con_id_pk=1665

here are a few pictures of equipment:

My question would be:
Why was this practice rarely used in civilians field? Was there some severe complication with it?
Wouldn't it provide a way to improve clotting thus survival rate like TXA does?

 

[SpecialK]

I know of no prehospital agencies carrying whole blood. Although that would be the best.thing to carry

NSW Ambulance (GSA-HEMS)
Air Ambulance Victoria (part of AV)
ARHT/Westpac Rescue (Auckland HEMS)
London HEMS
Medcall GmbH

All of these services respond by road as well as air. The QAS are carrying PRBCs.

I do not think it whole blood will become standard on every ambulance but as it becomes more practical to carry it will become more common for HEMS or the hyper-acute critical care paramedic environment. Of course, that is until science invents a whole blood substitute.

 

[Handsome Robb]

TXA doesn't increase survival.

http://www.jems.com/articles/print/...-prehospital-use-of-txa-may-be-premature.html


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[TransportJockey]

NSW Ambulance (GSA-HEMS)
Air Ambulance Victoria (part of AV)
ARHT/Westpac Rescue (Auckland HEMS)
London HEMS
Medcall GmbH

All of these services respond by road as well as air. The QAS are carrying PRBCs.

I do not think it whole blood will become standard on every ambulance but as it becomes more practical to carry it will become more common for HEMS or the hyper-acute critical care paramedic environment. Of course, that is until science invents a whole blood substitute.

Fair enough. I completely spaced that in other countries they might be carrying whole blood. Here in the US, components are common whereas whole blood is not

 

[RedAirplane]

My understanding is that the demand for blood is way down because hospitals now have a way to keep the same packet viable for longer. However, this is admittedly imprecise information so if someone can explain that it'd be great.

 

[Ensihoitaja]

We're part of a study on carrying and administering fresh frozen plasma on the ambulance. We're 2 years in and there's another year to go. I know the trauma surgeons are really excited about it, but I don't have any idea what preliminary results have been like.

COMBAT Study- http://www.denverhealth.org/for-pro...-center/research-and-publications/combattrial

 

[TransportJockey]

We're part of a study on carrying and administering fresh frozen plasma on the ambulance. We're 2 years in and there's another year to go. I know the trauma surgeons are really excited about it, but I don't have any idea what preliminary results have been like.

COMBAT Study- http://www.denverhealth.org/for-pro...-center/research-and-publications/combattrial

Ya'll are always doing all sorts of cool **** up there. I can't wait to read what thr esults from the study show.

 

[Ensihoitaja]

Definitely a benefit of being part of the hospital.

 

[Meursault]

Taming the SRU mentioned a while back that their HEMS service was trying fresh (non-frozen) plasma due to shelf life advantages.
http://www.tamingthesru.com/blog/prehospital-medicine/liquid-plasma-aka-never-frozen-plasma
I don't know if they're still doing it or have published anything.
Another interesting point from (I think) that podcast: the US started fractionating blood products for oncology patients, not because of benefits in storage or efficacy in trauma.

 

[Ensihoitaja]

One interesting comparison for the COMBAT study versus the fresh plasma mentioned in the podcast... our FFP is 500 mL frozen in a 2 L bag, so it's flat with a lot of surface area. We can thaw one unit in a plasmatherm in 3 minutes, 20 seconds and a second in another 3:20.

 

[MonkeyArrow]

Another interesting thing that could eventually make its way over here is FLyP. Stands for French Lyophilized Plasma, and is basically freeze dried plasma. Stored in a bottle, and has a shelf life at room temperature for years. You reconstitute it with sterile water I believe, and its ready for infusion in about 5 minutes. It is currently in small scale tests with French and US special operations forces. Obviously, right now, it is very expensive.

 

[Ensihoitaja]

Another interesting thing that could eventually make its way over here is FLyP. Stands for French Lyophilized Plasma, and is basically freeze dried plasma. Stored in a bottle, and has a shelf life at room temperature for years. You reconstitute it with sterile water I believe, and its ready for infusion in about 5 minutes. It is currently in small scale tests with French and US special operations forces. Obviously, right now, it is very expensive.

According to the trauma service, freeze-dried plasma is where there hoping to go next if the COMBAT/FFP study has positive results.

 

[VFlutter]

Fair enough. I completely spaced that in other countries they might be carrying whole blood. Here in the US, components are common whereas whole blood is not

I believe the local HEMS carry 2 units of PRBC and 2 units of FFP on their helicopters.