Plasma-first resuscitation to treat haemorrhagic shock in urban areas – Authors' reply

Since the publication of our Control of Massive Bleeding After Trauma (COMBAT) trial results,1 we have received extensive constructive feedback on the outcome and design of this study, and on the utility of blood plasma as the initial resuscitation fluid in a prehospital setting. [...]the benefit from plasma in combined populations of the two trials is primarily seen in blunt injury, whereas penetrating injury is predominant in the COMBAT trial (62 [50%] out of 125 patients in COMBAT have a penetrating injury vs 95 [19%] out of 501 patients in PAMPer), most likely because of the urban setting.2 Second, the patients that benefited the most from plasma in the PAMPer study were those who ultimately required between 4–7 units of red blood cells.3 Fewer than 20 patients in the COMBAT study were in this moderate range of transfusion requirement, with the majority of patients requiring either no blood products or a massive transfusion. [...]this post-hoc finding is difficult to interpret, as volume of transfused blood is a key outcome metric.