title: Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial.
abstract: BACKGROUND
  The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request.
  
  
  METHODS
  At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines.
  
  
  RESULTS
  Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared.
  
  
  CONCLUSIONS
  Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.
authors.affiliation: Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Novak
authors.affiliation: Department of Pathology and Laboratory Medicine, Medical School.
authors.forename: Yu
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Department of Pathology, School of Medicine, University of Maryland, College Park, Maryland.
authors.forename: Rhonda K
authors.initials: RK
authors.lastname: Cooke
authors.affiliation: Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Marisa B
authors.initials: MB
authors.lastname: Marques
authors.affiliation: Department of Pathology, School of Medicine, University of Maryland, College Park, Maryland.
authors.forename: Magali J
authors.initials: MJ
authors.lastname: Fontaine
authors.affiliation: Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Gottschall
authors.affiliation: Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Carey
authors.affiliation: Division of Laboratory Medicine, Department of Pathology.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Scanlan
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Eberhard W
authors.initials: EW
authors.lastname: Fiebig
authors.affiliation: Department of Pathology, Keck School of Medicine.
authors.forename: Ira A
authors.initials: IA
authors.lastname: Shulman
authors.affiliation: Department of Pathology, Keck School of Medicine.
authors.forename: Janice M
authors.initials: JM
authors.lastname: Nelson
authors.affiliation: Clinical Laboratories, Regional Medical Center, Memphis, Tennessee.
authors.forename: Sherri
authors.initials: S
authors.lastname: Flax
authors.affiliation: Clinical Laboratories, Regional Medical Center, Memphis, Tennessee.
authors.forename: Veda
authors.initials: V
authors.lastname: Duncan
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Daniel-Johnson
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Callum
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Fox
authors.affiliation: Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baraniuk
authors.affiliation: Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Tilley
authors.affiliation: Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
authors.affiliation: Division of Trauma and Critical Care, University of Southern California, Los Angeles, California.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Trauma and Acute Care Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Podbielski
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
mesh_terms: D000017:ABO Blood-Group System / Q000097:blood; D001771:Blood Banks / Q000706:statistics & numerical data; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D001793:Blood Preservation; D015925:Cryopreservation; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data*; D010949:Plasma; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012151:Resuscitation; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000150:complications*; D000094902:Blood Banking / Q000379:methods
chemical_list: D000017:ABO Blood-Group System
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