title: Use of freeze-dried plasma in French intensive care unit in Afghanistan.
abstract: BACKGROUND
  Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Massive hemorrhage management includes transfusion of red blood cells and plasma in a 1:1 ratio. Fresh frozen plasma requires thawing and badly fits the emergency criteria. Since 1994, the French Military Blood Bank has been producing freeze-dried plasma (FDP) and providing it for overseas operation. The aim of our study was to evaluate the use of FDP in war settings and to assess its clinical efficiency and safety.
  
  
  METHODS
  We performed a prospective study of the FDP delivered at the International Security Assistance Force Role 3 Military Medical Treatment Facility in the Kabul Afghanistan International Airport between February 2010 and February 2011. We included every patient who received at least one unit of FDP. Basic clinical data were recorded at admission. Transfusion requirements were monitored. Biological testing were performed before and after administration of FDP including hemoglobin concentration, platelets count, fibrinogen level, prothrombin time (PT), and thromboelastography.
  
  
  RESULTS
  Eighty-seven casualties received FDP during 93 episodes of transfusion. On average, 3.5 FDP units were transfused per episodes of transfusion. Of the 87 patients studied, 7 died because of nonsurvivable injuries and outcomes were unavailable for 11. The other 59 patients survived. PT significantly declined by an average of 3.3 seconds after FDP transfusion. This moderate decrease in PT reflects continued bleeding and resuscitation. It nevertheless suggests improvement in hemostasis before surgical control of bleeding. All FDP users reported ease of use, clinically observed efficacy equivalent to fresh frozen plasma and the absence of adverse effects associated with FDP.
  
  
  CONCLUSIONS
  Our results provide evidence of the effectiveness of FDP for the prevention or correction of coagulopathy and hemorrhage in combat casualties.
authors.affiliation: Fédération de Biologie Clinique, Hôpital d'Instruction des Armées Percy, Clamart, France. christophe.martinaud@inserm.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Martinaud
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ausset
authors.forename: Anne Virginie
authors.initials: AV
authors.lastname: Deshayes
authors.forename: Amandine
authors.initials: A
authors.lastname: Cauet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demazeau
authors.forename: Anne
authors.initials: A
authors.lastname: Sailliol
mesh_terms: D000328:Adult; D000346:Afghanistan; D016913:Blood Component Transfusion / Q000379:methods*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D005602:France; D005612:Freeze Drying; D006489:Hemostatic Techniques; D006772:Hospitals, Military; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D014857:Warfare; D055815:Young Adult