PAMPer

Population

• Injured patients at risk for hemorrhagic shock who were transported by air medical services.

Intervention

Prehospital administration of thawed plasma during air medical transport.

Comparator

Standard-care resuscitation during air medical transport.

Key results

• 30-day mortality was 23.2% with plasma vs 33.0% with standard care; difference -9.8 percentage points (95% CI -18.6 to -1.0%; P=0.03).
• The treatment effect was similar across nine prespecified subgroups.
• Kaplan-Meier curves separated by 3 hours after randomization and the separation persisted to 30 days.
• Median prothrombin-time ratio on arrival was lower with plasma (1.2 vs 1.3).

Harms

• No significant differences were noted in multiorgan failure, acute lung injury-ARDS, nosocomial infections, or allergic or transfusion-related reactions.

Practice impact

• When air-transport times allow, give thawed plasma before hospital arrival to trauma patients at risk for hemorrhagic shock.

Applicability

• Most applicable to injured patients at risk for hemorrhagic shock who are already on air medical transport.

Limitations

• The comparison was cluster-randomized plasma versus standard-care resuscitation, not an individually randomized comparison.
• The abstract does not specify geography or the exact physiologic thresholds used to define hemorrhagic-shock risk.
• Benefit may not apply when ground transport to a trauma center is already very short.

Common misinterpretations

• This does not mean every urban ground ambulance must carry plasma; the setting was air medical transport.
• Similar rates of the listed complications are not a license to ignore transfusion reactions.