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Invited Commentary
September 22, 2021

CHEERS to You on a Well-done Cost-effectiveness Analysis of Prehospital Plasma for Helicopter Resuscitation of Patients With Traumatic Shock

Author Affiliations
  • 1Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center–Houston, Houston
  • 3The Red Duke Trauma Institute at Memorial Hermann Hospital, Texas Medical Center, Houston
  • 4Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 5Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 6The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
  • 7Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Surg. 2021;156(12):1139-1140. doi:10.1001/jamasurg.2021.4530

Plasma has long been advocated as the early go-to blood product for resuscitation of hemorrhagic shock. Plasma contains necessary coagulation factors, decreases the inflammatory response, promotes endothelial repair, and decreases extracellular edema. In 2013, Radwan et al1 demonstrated that moving thawed plasma from the blood bank to the trauma bay resulted in decreased time to plasma transfusion, reduction in overall blood product use, and 50% improvement in survival among trauma patients in hemorrhagic shock. Building on these findings and moving this critical product closer to the point of injury, the Prehospital Plasma in Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock (PAMPer) trial showed that prehospital helicopter administration of thawed plasma conferred a significant survival advantage for injured patients at risk for hemorrhagic shock.2 Unfortunately, this practice has not yet been adopted at all aeromedical trauma systems, predominantly because of concerns about feasibility and cost, common barriers to implementation in health care.3

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