title: Prehospital use of plasma in traumatic hemorrhage (The PUPTH Trial): study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Severe traumatic injury and haemorrhagic shock are frequently associated with disruptions of coagulation function (such as trauma-induced coagulopathy TIC) and activation of inflammatory cascades. These pathologies may be exacerbated by current standard of care resuscitation protocols. Observational studies suggest early administration of plasma to severely-injured haemorrhaging patients may correct TIC, minimise inflammation, and improve survival. The proposed randomised clinical trial will evaluate the clinical effectiveness of pre-hospital plasma administration compared with standard- of-care crystalloid resuscitation in severely-injured patients with major traumatic haemorrhage.
  
  
  METHODS
  This is a prospective, randomized, open-label, non-blinded trial to determine the effect of pre-hospital administration of thawed plasma (TP) on mortality, morbidity, transfusion requirements, coagulation, and inflammatory response in severely-injured bleeding trauma patients. Two hundred and ten eligible adult trauma patients will be randomised to receive either two units of plasma, to be administered in-field, vs standard of care normal saline (NS). Main analyses will compare subjects allocated to TP to those allocated to NS, on an intention-to-treat basis. Primary outcome measure is all-cause 30-day mortality. Secondary outcome measures include coagulation and lipidomic/pro-inflammatory marker responses, volume of resuscitation fluids (crystalloid, colloid) and blood products administered, and major hospital outcomes (e.g. incidence of MSOF, length of ICU stay, length of hospital stay).
  
  
  CONCLUSIONS
  This study is part of a US Department of Defense (DoD)-funded multi-institutional investigation, conducted independently of, but in parallel with, the University of Pittsburgh and University of Denver. Demonstration of significant reductions in mortality and coagulopathic/inflammatory-related morbidities as a result of pre-hospital plasma administration would be of considerable clinical importance for the management of haemorrhagic shock in both civilian and military populations.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02303964 on 28 November 2014.
authors.affiliation: Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA. psreynolds@vcu.edu.
authors.forename: Penny S
authors.initials: PS
authors.lastname: Reynolds
authors.affiliation: Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA. mmichael@vcu.edu.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Michael
authors.affiliation: Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA. edcochran@vcu.edu.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Cochran
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA. jacobwegelin@fastmail.fm.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Wegelin
authors.affiliation: Department of Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA. bdspiess@hsc.vcu.edu.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Spiess
mesh_terms: D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001810:Blood Volume; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000379:methods*; D005440:Fluid Therapy; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015601:Injury Severity Score; D057194:Intention to Treat Analysis; D007902:Length of Stay; D010949:Plasma; D011446:Prospective Studies; D012107:Research Design; D012771:Shock, Hemorrhagic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D059030:United States Department of Defense; D014947:Wounds and Injuries / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators