Group A emergency-release plasma in trauma patients requiring massive transfusion

J Trauma Acute Care Surg. 2020 Dec;89(6):1061-1067. doi: 10.1097/TA.0000000000002903.


Background: Both groups A and AB plasma have been approved for emergency-release transfusion in acutely bleeding trauma patients before blood grouping being performed. The safety profile associated with this practice has not been well characterized, particularly in patients requiring massive transfusion.

Methods: This secondary analysis of the Pragmatic, Randomized, Optimal Platelet and Plasma Ratios trial examined whether exposure to group A emergency-release plasma (ERP) was noninferior to group AB ERP. We also examined patients whose blood groups were compatible with group A ERP versus patients whose blood groups were incompatible with group A ERP. Outcomes included 30-day mortality and complication rates including systemic inflammatory response syndrome, infection, renal injury, pulmonary dysfunction, and thromboembolism.

Results: Of the 680 patients predicted to receive a massive transfusion, 584 (85.9%) received at least 1 U of ERP. Of the 584 patients analyzed, 462 (79.1%) received group AB and 122 (20.9%) received group A ERP. Using a hazard ratio (HR) of 1.35 as the noninferiority margin, transfusion with group A versus group AB ERP was not associated with increased thromboembolic rates (HR, 0.52; 95% confidence interval [CI], 0.31-0.90). Mortality (HR, 1.15; 95% CI, 0.91-1.45) and nonfatal complication rates (HR, 1.24; 95% CI, 0.87-1.77) were inconclusive. In the subgroup analysis, transfusion with incompatible ERP (group B or AB patients receiving group A ERP) was not associated with increased nonfatal complications (HR, 1.02; 95% CI, 0.80-1.30). There were no reported hemolytic transfusion reactions.

Conclusion: The use of ERP is common in patients requiring massive transfusion and facilitates the rapid balanced resuscitation of patients who have sustained blood loss. Group A ERP is an acceptable option for patients requiring massive transfusion, especially if group AB ERP is not readily available.

Level of evidence: Therapeutic/Care Management, level IV; Prognostic, level III.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Pragmatic Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Blood Component Transfusion / methods*
  • Blood Group Incompatibility*
  • Blood Grouping and Crossmatching
  • Emergencies
  • Female
  • Hemorrhage / mortality
  • Hemorrhage / therapy*
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Plasma*
  • Proportional Hazards Models
  • Resuscitation / methods*
  • Risk Factors
  • Trauma Centers
  • Treatment Outcome
  • United States
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy
  • Young Adult