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September 21, 2009

Lyophilized Plasma for Resuscitation in a Swine Model of Severe Injury

Author Affiliations

Author Affiliations: Division of Trauma and Critical Care, Oregon Health and Science University, Portland (Drs Spoerke, Zink, Cho, Karahan, and Schreiber and Messrs Differding and Muller); Office of the Director of Combat Casualty Care Research, US Army Institute of Surgical Research, San Antonio, Texas (Dr Sondeen); and Division of Acute Care Surgery, The University of Texas at Houston (Dr Holcomb).

Arch Surg. 2009;144(9):829-834. doi:10.1001/archsurg.2009.154

Hypothesis  Lyophilized plasma (LP) is as safe and effective as fresh frozen plasma (FFP) for resuscitation after severe trauma.

Design  Multicenter animal study.

Setting  Animal laboratories, 2 level I trauma centers.

Participants  Thirty-two Yorkshire crossbred swine.

Interventions  Lyophilized plasma was analyzed for factor levels and clotting activity before lyophilization and after reconstitution. Swine were subjected to complex multiple trauma including extremity fracture, hemorrhage, severe liver injury, acidosis, and hypothermia. They were then resuscitated with FFP, LP, FFP and packed red blood cells (PRBCs) in a ratio of 1:1, or 1:1 LP and PRBCs.

Main Outcome Measures  Residual clotting activity of LP after reconstitution, swine mortality, hemodynamic measures, total blood loss, coagulation profiles, and inflammatory measures.

Results  Lyophilization decreased clotting factor activity by an average of 14%. Survival and heart rate were similar between all groups. Swine resuscitated with LP had equivalent or higher mean arterial pressures. Swine treated with LP had similar coagulation profiles, plasma lactate levels, and postinjury blood loss compared with those treated with FFP. Swine treated with 1:1 FFP-PRBCs were similar to those treated with 1:1 LP-PRBCs. Resuscitation with LP resulted in a reduction in postresuscitation interleukin 6 expression compared with resuscitation with FFP.

Conclusions  The process of lyophilization and reconstitution of plasma reduces coagulation factor activity by 14%, without acute differences in blood loss. Lyophilized plasma can be used for resuscitation in a severe multiple trauma and hemorrhagic shock swine model with efficacy equal to that of FFP and with decreased interleukin 6 production.