title: Using Fresh Frozen Plasma for Acute Airway Angioedema to Prevent Intubation in the Emergency Department: A Retrospective Cohort Study.
abstract: Background. Angioedema (AE) is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP) in treating severe acute bouts of AE, little evidence-based support for this practice is available at present. Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP. Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007-2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not). Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%; p = 0.05) and ICU stay (3.5 days versus 1.5 days; p < 0.001). Group outcomes were otherwise similar. Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine). Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines.
authors.affiliation: Department of Internal Medicine, St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48236, USA; Geriatric Research Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, 2215 Fuller Road 11 G, Ann Arbor, MI 48105, USA; Department of Internal Medicine, University of Michigan, 3110 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Aya
authors.identifier: 0000-0002-3576-6343
authors.initials: A
authors.lastname: Saeb
authors.affiliation: Department of Internal Medicine, St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48236, USA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Hagglund
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, 2215 Fuller Road 11 G, Ann Arbor, MI 48105, USA; Department of Internal Medicine, University of Michigan, 3110 Taubman Center, SPC 5368, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Family Medicine, University of Michigan, 1150 W. Medical Center Drive, M7300 Med Sci I, SPC 5625, Ann Arbor, MI 48109, USA.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Cigolle