A/Prof. Ben Meadley
1Ambulance Victoria and Monash University, ,
Abstract:
Aims: Transfusion of a high ratio of plasma to packed red blood cells (PRBCs) has been associated with survival after major trauma. However, the effect of prehospital plasma on patient outcomes has been inconsistent. The aim of this trial was to assess the feasibility of transfusing freeze-dried plasma with red blood cells (RBCs) using a randomised controlled design in an aeromedical prehospital setting.
Methods: Patients attended by helicopter emergency medical service (HEMS) paramedics with suspected critical bleeding after trauma managed with prehospital RBCs were randomised to receive 2 units of freeze-dried plasma or standard care (no plasma). The primary outcome was the proportion of eligible patients enrolled and provided the intervention. Secondary outcomes included preliminary data on effectiveness, including mortality at 24 h and at hospital discharge, and adverse events.
Results: During the study period, there were 25 eligible patients, of whom 20 (80%) were enrolled in the trial and 19 (76%) received the allocated intervention. Median time from randomisation to hospital arrival was 92.5 min (IQR 68–101.5 min). Mortality may have been lower in the freeze-dried plasma group at 24 h (RR 0.24, 95% CI 0.03–1.73) and at hospital discharge (RR 0.73, 95% CI 0.24–2.27). No serious adverse events related to the trial interventions were reported.
Conclusions: This first reported experience of freeze-dried plasma use in Australia suggests prehospital administration is feasible. Given longer prehospital times typically associated with HEMS attendance, there is potential clinical benefit from this intervention and rationale for a definitive trial.
Biographies:
Ben Meadley is a registered paramedic who commenced his career with Ambulance Victoria in 1998, followed by a period with New South Wales Ambulance from 1999-2003. Returning to Ambulance Victoria, Ben trained as an intensive care (MICA) paramedic in 2004, and an intensive care (MICA) flight paramedic in 2009. Ben completed his PhD at Monash University, investigating the physiological and cardiometabolic health of paramedics. Ben has developed expertise in prehospital critical care, paramedic education, and human performance in specialist teams. His research interests include respiratory and cardiovascular physiology, point of care ultrasound, blood component use in critical care, human performance optimisation, and helicopter search and rescue operations. Ben currently divides his time between clinical, systems improvement and research roles. He is a Fellow of the Australasian College of Paramedicine and was awarded the Ambulance Service Medal in 2023.