U.K. Plasma Trial Sees "Unexpected Survivors"
The early results of a new trial using plasma has seen yet more “unexpected survivors.”
The trial, which builds on the life-saving ‘Blood on Board’ technique, saw the Great North Air Ambulance Service (GNAAS) carry defrosted fresh frozen plasma on board one of its aircraft for the first time in May last year.
Following a review of five months’ data, early results demonstrate what the region’s trauma experts had hoped for: Carrying plasma, as well as blood, has saved even more lives.
Dr Rachel Hawes, GNAAS aircrew doctor and consultant in anaesthesia and prehospital emergency medicine at Newcastle’s Royal Victoria Infirmary (RVI), brought ‘Blood on Board’ to the North of England in 2015. She explains the importance of these new results: “We’re delighted to see evidence that using fresh frozen plasma alongside red blood cell transfusions, when stabilizing patients with life threatening injuries, has had such a positive impact. Across the first five months of the new trial we have seen three unexpected survivors which is fantastic news. In fact we treated 36 patients using the blood on board technique during these five months—this compares to 37 throughout the whole of our first year practicing ‘Blood on Board.’ This shows how much this new approach has become routine practice when needed, and means that major trauma patients are alive today because of the rapid transfusions they received at the scene of their accident.”
Plasma provides vital clotting components to help blood clots to form and to stop bleeding. Before the introduction of plasma, patients would be stabilized using blood transfusions by the GNAAS air doctor, and then receive plasma on arrival at a Major Trauma Centre.
However, on arrival in A&E a third of patients with severe bleeding were no longer able to form blood clots normally, leaving them in a condition known as coagulopathy—they hadn’t been able to produce enough of their own blood clots to keep up with the bleeding and so the bleeding had spiraled out of control.
Giving a more balanced transfusion, using equal volumes of red blood cells and plasma, has now been shown to prevent this from happening, and furthermore has thrown up an expected surprise benefit for critically injured patients.
“We always hoped the balanced transfusion technique would mean more patients arriving at hospital with their bleeding under control and minimal abnormal clotting," Hawes explains. "What we didn’t expect to see was that these patients then required fewer transfusions in hospital. We are delighted to be in a position to provide the most up-to-date clinical techniques, giving our patients the best possible chance of survival.”
GNAAS, which is planning to build a regional Centre of Medical Excellence to enable more research projects, teamed up with Newcastle Hospitals, blood bikes charities in Northumbria and Cumbria and the Henry Surtees Foundation to become one of the very first air ambulance charities in the UK to carry plasma as well as blood on board.
On a daily basis, a volunteer from both Northumbria Blood Bikes and Blood Bikes Cumbria collect a cool box from the RVI’s Blood Laboratories. The cool boxes are then transported to the two GNAAS airfields – Durham Tees Valley Airport and Langwathby, near Penrith.
The cool boxes keep two units of blood and two units of plasma cool for up to 48 hours and if not used, they are returned to the RVI to be used during surgery and other procedures in the hospital.
The statistics during the five month trial:
- 376 cool boxes were prepared and delivered, split 50:50 with blood + plasma;
- 36 patients received ‘blood on board’;
- 3 patients who survived were “unexpected survivors”;
- 50% of patients were involved in a road traffic collision; 15% had had a serious fall and 12.5% were victims of stabbings.