Pre-Hospital Use of Plasma for Traumatic Hemorrhage (PUPTH)

Virginia Commonwealth University (VCU)

Status and phase: Withdrawn; Phase 3; Phase 2

Conditions: Shock, Hemorrhagic

Treatments: Drug: Normal saline; Biological: Plasma

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT02303964

IND #15910 (Registry Identifier)

HM14813

W81XWH-12-2-0022 (Other Grant/Funding Number)

Details and patient eligibility

About

Type A Thawed Plasma (TP) will be compared in polytrauma patients who receive only Normal Saline (NS) (standard of care) before arrival at the hospital.

The purpose of this study is to determine if prehospital administration of thawed plasma can reduce mortality of patients who have lost a large amount of blood due to their injuries, compared to those receiving standard of care.

Full description

INVESTIGATIONAL PLAN This will be an open-label, non-blinded, randomized clinical trial to investigate mortality (30 days) and morbidity of Type A thawed Plasma (TP) versus NS infusion at earliest contact, administered by Emergency Medical Service (EMS) supervisors to subjects who have sustained severe Polytrauma / Major hemorrhage (PTr / MH). The total study is expected to last 2 years with 210 patients enrolled.

The two EMS agencies involved in the study will each have one EMS supervisor quick-response vehicle (QRV) equipped with an approved, validated refrigeration unit for TP transport. EMS personnel trained in plasma administration and recognition of reactions may administer up to 2 units of TP to subjects approved for study enrollment. Blood samples for coagulation and lipid testing will be drawn prior to TP administration by EMS personnel,and repeated by hospital personnel at 30 minutes, 8 hours, and 24 hours post-injury.

This study is approved for "Exception from Informed Consent" (EFIC). Once the patient has reached VCUMC and has been entered into the VCUMC health care system, the treating team will advise the Study Coordinator (SC) whether or not a subject is able to consent. As the plasma administration will occur in the field prior to arrival to VCUMC, the SC will make every effort possible to obtain consent from the subject or legally authorized representative (LAR) for continued study participation before the next intervention (8 hour blood specimen collection). The attempts to contact the LAR will be documented in detail. If a subject lacks the ability to provide his/her own consent by the end of day 30, the consent signed by the LAR will be the consent document in force at the subject's completion of the study and no further consent will be sought.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Blunt or penetrating trauma,
• Blood Pressure (BP) systolic <70 mmHg or BP 70-90 mmHg with Heart Rate (HR) > 108 Beats Per Minute (BPM),
• Ongoing hemorrhage with unstable vital signs

Exclusion criteria

• Wearing opt-out wrist band,
• Wearing medical alert jewelry / bracelet, etc. indicating Jehovah Witness or similar with objections to blood transfusions,
• Refusal to participate (by subject or LAR),
• Communication barrier at the time of eliciting refusal (non-English speaking or non-Spanish speaking),
• Not expected to survive transport to Virginia Commonwealth University Medical Center (VCUMC),
• Documented Do Not Resuscitate (DNR) order found,
• Cardiac arrest or Cardio-Pulmonary Resuscitation (CPR) prior to randomization
• Penetrating head trauma,
• Known / obvious pregnancy,
• Prisoner,
• Burns > 20% of body surface

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

0 participants in 2 patient groups, including a placebo group

Type A Thawed Plasma

Active Comparator group

Description:

Eligible subjects with polytrauma (PT) and major hemorrhage (MH) will be randomized to receive 2 units of thawed Type A plasma in the pre-hospital setting administered by EMS first responders. An exception from informed consent under 21CFR 50.24 is required since enrollment will occur (for the majority of subjects) before consent can be obtained.

Treatment:

Biological: Plasma

Normal saline

Placebo Comparator group

Description:

Eligible subjects with polytrauma (PT) and major hemorrhage (MH) will be randomized to receive normal saline in the pre-hospital setting administered by EMS first responders. Normal saline is standard of care

Treatment:

Drug: Normal saline