PreHospital Air Medical Plasma Trial

Background: Although advances in the care of the severely injured patient have occurred over
the last decade, patients continue to be plagued with uncontrolled hemorrhage resulting in
significant early mortality and the development of multiple organ failure and associated
complications. A primary driving force for this unbridled hemorrhage has been shown to be the
early coagulopathy which complicates severe injury. Increasing evidence suggests that blood
component transfusion protocols that address this early coagulopathy, once a patient arrives
at a trauma center, are associated with lower mortality and a reduction in blood component
transfusion requirements. Prehospital interventions which quell this early coagulopathy in an
earlier setting have the potential to minimize or even prevent this vicious hemorrhagic
cascade, further lowering blood component transfusion requirements and reducing the resultant
morbid sequelae which complicates severe injury.

Objective/Hypothesis: The primary hypothesis will be that prehospital infusion of plasma
during air medical transport in patients with hemorrhagic shock will lower 30 day mortality.
The secondary hypotheses include that prehospital infusion of plasma will reduce 24 hour
blood transfusion, multiple organ failure, nosocomial infection, and acute lung injury,
reduce or prevent the early coagulopathy as demonstrated by improving presenting coagulation
and thromboelastography parameters, and reduce the early inflammatory cytokine response,
thrombomodulin and increase protein C levels.

Inclusion Criteria: Hemorrhagic shock not responsive to crystalloid infusion -

Exclusion Criteria: Isolated Fall, Cervical cord injury, prisoner, pregnant patient,
traumatic arrest