The administration of high ratios of plasma to packed red blood cells (PRBC) has been widely adopted for in-hospital treatment of major traumatic haemorrhage. The rationale is to provide “haemostatic resuscitation” (HR) to address trauma-induced coagulopathy (TIC), which carries a fourfold increase in mortality. Evidence for HR is almost exclusively derived from observational studies. The best treatment for injured patients with major bleeding before reaching hospital is uncertain; patients are usually given clear fluids (salt solution) through a drip and may receive blood products after arriving in hospital. Some research suggests that giving blood products before the patient reaches the hospital may improve clinical outcomes, but this has not yet been proven. This trial is being carried out across regional trauma networks in England. Injured patients with major bleeding are divided randomly into two groups. Both groups are treated by pre-hospital emergency teams (with both doctors and paramedics) at the scene and during transport to hospital. One group receives the “standard treatment” – small volumes of clear fluid. The other group receives blood products (small volumes of red blood cells and freeze dried plasma). We want to see which treatment is better.
The principle objective of this trial is to investigate the clinical effectiveness of packed red blood cells (PHBP) resuscitation compared to the current standard care of restricted, crystalloid-based resuscitation in participants suffering from major traumatic haemorrhage.
Dr Nick Crombie/Prof Gavin Perkins