title: Early resuscitation with fresh frozen plasma for traumatic brain injury combined with hemorrhagic shock improves neurologic recovery.
abstract: BACKGROUND
  We have shown that early administration of fresh frozen plasma (FFP) reduces the size of brain lesions 6 hours after injury in a large animal model of traumatic brain injury (TBI) and hemorrhagic shock (HS). To examine long-term outcomes, we hypothesized that early treatment with FFP would result in faster neurologic recovery and better long-term outcomes in a combined TBI and HS model.
  
  
  METHODS
  Anesthetized Yorkshire swine underwent combined TBI and volume-controlled hemorrhage (40% blood volume). After 2 hours of shock, animals were randomized (n = 5/group) to normal saline (3× shed blood) or FFP (1× shed blood) treatment. A neurologic severity score was assessed for 30 days. Magnetic resonance imaging of the brain was performed at days 3, 10, and 24. Cognitive function was tested by training animals to retrieve food from color-coded boxes.
  
  
  RESULTS
  Neurologic impairment was lower and speed of recovery was considerably faster in the FFP-treated animals. There was a trend toward a smaller lesion size in FFP-treated animal at days 3 and 10, but this did not reach statistical significance. Both groups reached baseline performance on the cognitive testing; however, FFP-treated animals were able to participate, on average, 8 days earlier due to quicker recovery.
  
  
  CONCLUSIONS
  This is the first study to demonstrate the beneficial effects of FFP treatment in a long-term survival model of combined TBI and HS. Our data show that early treatment with FFP substantially attenuates the degree of neurologic impairment, improves the rate of recovery, and preserves the cognitive functions.
authors.affiliation: Department of Surgery, University of Michigan Hospital, Ann Arbor, MI.
authors.forename: Ihab
authors.initials: I
authors.lastname: Halaweish
authors.affiliation: Department of Surgery, University of Michigan Hospital, Ann Arbor, MI.
authors.forename: Ted
authors.initials: T
authors.lastname: Bambakidis
authors.affiliation: Department of Cardiothoracic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Emergency Medicine, Flevoziekenhuis Hospital, Almere, The Netherlands.
authors.forename: Durk
authors.initials: D
authors.lastname: Linzel
authors.affiliation: Department of Surgical Critical Care, Beijing Hospital Ministry of Health, Beijing, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Chang
authors.affiliation: Department of Radiology, Section of Neuroradiology, University of Michigan Hospital, Ann Arbor, MI.
authors.forename: Ashok
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: Department of Anesthesiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands.
authors.forename: Simone E
authors.initials: SE
authors.lastname: Dekker
authors.affiliation: Department of Surgery, University of Michigan Hospital, Ann Arbor, MI.
authors.forename: Baoling
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Surgery, University of Michigan Hospital, Ann Arbor, MI.
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Surgery, University of Michigan Hospital, Ann Arbor, MI. Electronic address: alamh@med.umich.edu.
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
mesh_terms: D000818:Animals; D016913:Blood Component Transfusion; D001921:Brain / Q000473:pathology; D001930:Brain Injuries / Q000150:complications / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D003071:Cognition; D005260:Female; D008279:Magnetic Resonance Imaging; D010949:Plasma; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000150:complications / Q000628:therapy*; D013552:Swine; D016896:Treatment Outcome