Hemostatic and pharmacologic resuscitation: results of a long-term survival study in a swine polytrauma model.

Alam HB, Hamwi KB, Duggan M, et al.

J Trauma 2011;70:636-645.

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Review by : A. Godier
NATA Review

To improve the outcome of severe trauma, the management of massive hemorrhage must begin rapidly. However, this immediate “damage control resuscitation” faces logistic limitations, especially regarding blood product availability. Alam et al. investigate the place of valproic acid (VPA) and lyophylized freeze dried plasma (FDP) in the early treatment of polytrauma in a swine model. They compare these two strategies to starch-based fluid therapy, selected as control, and to fresh whole blood, used as the ideal therapy.

FDP improves survival compared to control without any long-term organ dysfunction or complications. However, this concept is not new. Freeze-dried plasma is already produced in several countries (Germany, France, South Africa, Thailand) and the French Army has been using a viro-attenuated FDP, with universal blood group compatibility, for a few years on the battlefield. This animal study emphasizes the benefits of this ready-to-use plasma and its availability for immediate resuscitation of severe trauma patients.

The results for VPA, although negative, are of special interest. This histone deacetylase inhibitor has no effect on hemostasis but is known to promote cellular survival during severe stress. Here, VPA doubles the swine survival rate. This improvement, while not statistically significant, raises the question of the potential benefit of such pharmaceutical agents. The next step for the authors is to combine VPA and FDP, looking for synergic effects. We look forward to their results!

– Anne Godier