院前航空医疗解冻血浆项目的实施：这是否可行？
Implementation of a prehospital air medical thawed plasma program: Is it even feasible?
机构信息
From the Division of Trauma and General Surgery, Department of Surgery (P.W.A., K.A.W., J.B.B., A.T.P., B.S.Z., M.D.N., J.L.S.), and Department of Emergency Medicine (F.X.G.), University of Pittsburgh Medical Center; Vitalant, and Department of Pathology (M.H.Y.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery (B.J.D.), University of Tennessee Health Science Center, Knoxville; Department of Surgery (R.S.M.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (B.G.H.), University of Louisville, Louisville, Kentucky; MetroHealth Medical Center (J.A.C.), Case Western Reserve University, Cleveland, Ohio; Department of Surgery (H.A.P.), University of Texas Southwestern, Parkland Hospital, Dallas; and Health Harris Methodist Hospital (W.R.W.), Fort Worth, Texas.
出版信息
J Trauma Acute Care Surg. 2019 Nov;87(5):1077-1081. doi: 10.1097/TA.0000000000002406.
BACKGROUND
The Prehospital Air Medical Plasma (PAMPer) trial demonstrated a 30-day survival benefit among hypotensive trauma patients treated with prehospital plasma during air medical transport. We characterized resources, costs and feasibility of air medical prehospital plasma program implementation.
METHODS
We performed a secondary analysis using data derived from the recent PAMPer trial. Intervention patients received thawed plasma (5-day shelf life). Unused plasma units were recycled back to blood bank affiliates, when possible. Distribution method and capability of recycling varied across sites. We determined the status of plasma units deployed, utilized, wasted, and returned. We inventoried thawed plasma use and annualized costs for distribution and recovery.
RESULTS
The PAMPer trial screened 7,275 patients and 5,103 plasma units were deployed across 22 air medical bases during a 42-month period. Only 368 (7.2%) units of this total thawed plasma pool were provided to plasma randomized PAMPer patients. Of the total plasma pool, 3,716 (72.8%) units of plasma were returned to the blood bank with the potential for transfusion prior to expiration and 1,019 (20.0%) thawed plasma units were deemed wasted for this analysis. The estimated average annual cost of implementation of a thawed plasma program per air medical base at an average courier distance would be between US $24,343 and US $30,077, depending on the ability to recycle plasma and distance of courier delivery required.
CONCLUSION
A prehospital plasma program utilizing thawed plasma is resource intensive. Plasma waste can be minimized depending on trauma center and blood bank specific logistics. Implementation of a thawed plasma program can occur with financial cost. Products with a longer shelf life, such as liquid plasma or freeze-dried plasma, may provide a more cost-effective prehospital product relative to thawed plasma.
LEVEL OF EVIDENCE
Therapeutic, level III.
背景
院前航空医疗血浆（PAMPer）试验表明，在航空医疗转运中接受院前血浆治疗的低血压创伤患者，30 天生存率有所提高。本研究旨在分析航空医疗院前血浆计划实施的资源、成本和可行性。
方法
我们使用来自最近的 PAMPer 试验的数据进行二次分析。干预组患者接受解冻的血浆（5 天保质期）。尽可能将未使用的血浆单位回收给血液银行分支机构。各站点的分配方法和回收能力各不相同。我们确定了部署、使用、浪费和返还的血浆单位的状态。我们清查了解冻血浆的使用情况，并对分配和回收的年度成本进行了估算。
结果
PAMPer 试验共筛选了 7275 例患者，在 42 个月的时间内，22 个航空医疗基地共部署了 5103 个血浆单位。在这总共解冻的血浆池中，只有 368 个（7.2%）单位提供给接受血浆随机分配的 PAMPer 患者。在总共的血浆池中，有 3716 个（72.8%）单位的血浆在过期前被送回血液银行，有可能在过期前进行输血，1019 个（20.0%）解冻的血浆单位在本分析中被认为是浪费。根据血浆回收能力和所需的快递距离，每个航空医疗基地实施解冻血浆计划的平均年度成本约为 24343 至 30077 美元。
结论
使用解冻血浆的院前血浆计划需要大量资源。根据创伤中心和血液银行的具体物流情况，可最大限度减少血浆浪费。实施解冻血浆计划会产生经济成本。与解冻血浆相比，保质期更长的产品，如液体血浆或冻干血浆，可能是一种更具成本效益的院前产品。
证据等级
治疗性，三级。
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