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This month’s update is from the University of Birmingham Acute Care Research Group. We used a multimodal search strategy, drawing on free open-access medical education resources and focused literature searches. We identified the five most interesting and relevant papers (decided by consensus, with editorial oversight) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial by Crombie et al
Rating: worth a peek
The optimal fluid for prehospital resuscitation in trauma is uncertain. Military studies suggest a significant survival advantage for trauma patients receiving prehospital transfusion of packed red blood cells (PRBCs) and pre-thawed plasma compared with crystalloid.1
This phase 3, open-label trial randomised 432 civilians with traumatic injury and hypotension due to haemorrhage, treated by critical care teams operating in the prehospital setting. Participants received either two units each of PRBCs and LyoPlas (freeze-dried plasma) or up to 1 L of 0.9% sodium chloride. The primary outcome was a composite of episode mortality and impaired lactate clearance (<20% fall from over the first 2 hours).
There was no statistically significant difference in the composite outcome (adjusted risk ratio 1.01, 95% CI 0.88 to 1.17), or in episode mortality and lactate clearance individually.
The sample size estimation specified 490 patients would be required to detect 0.82 relative risk with 80% power. Under-recruitment did not appear to influence the results in sensitivity analysis. The estimate of effect size may have been ambitious. The study is informative despite not demonstrating benefit. Do pre-existing assumptions around the pathogenicity of major haemorrhage need to be revisited? Learning from the battlefield may not directly translate to everyday practice. …
Contributors The manuscript was drafted by TK and SK with editorial comments and critical reviews by the remaining team members.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.