Lyophilized plasma for resuscitation in a swine model of severe injury.
OBJECTIVE
Lyophilized plasma (LP) is as safe and effective as fresh frozen plasma (FFP) for resuscitation after severe trauma.


METHODS
Multicenter animal study.


METHODS
Animal laboratories, 2 level I trauma centers.


METHODS
Thirty-two Yorkshire crossbred swine.


METHODS
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.


METHODS
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.
Division of Trauma and Critical Care, Oregon Health and Science University, Portland, OR 97239, USA. spoerken@ohsu.edu
Nicholas
N
Spoerke
Karen
K
Zink
S David
SD
Cho
Jerome
J
Differding
Patrick
P
Muller
Ayhan
A
Karahan
Jill
J
Sondeen
John B
JB
Holcomb
Martin
M
Schreiber
D000818:Animals; D000975:Antioxidants / Q000008:administration & dosage; D001205:Ascorbic Acid / Q000008:administration & dosage; D004195:Disease Models, Animal; D004211:Disseminated Intravascular Coagulation / Q000628:therapy; D005440:Fluid Therapy; D005612:Freeze Drying; D010949:Plasma; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy*
D000975:Antioxidants; D010952:Plasma Substitutes; D001205:Ascorbic Acid