From shortages to solutions: Liquid plasma as a practical alternative to whole blood for prehospital trauma resuscitation

Trauma-induced hemorrhagic shock remains a leading cause of preventable mortality, necessitating timely and effective resuscitation strategies. While low-titer O whole blood (LTOWB) is the preferred choice for prehospital resuscitation due to its balanced composition and ease of use, overall widespread implementation is hindered by persistent supply chain issues and daily logistical challenges of access and deployment. Platelets, containing plasma as a component, are considered the next best alternative to LTOWB but are constrained by their short shelf life and ongoing scarcity, and ongoing storage compliance, rendering their use impractical. This review evaluates plasma-based alternatives, particularly liquid plasma (LP), as a viable and cost-effective substitute therapeutic modality. LP offers a 26-day refrigerated shelf life compared to the 5-day limit of thawed fresh frozen plasma (FFP) and eliminates the challenges associated with freezing and thawing while maintaining clinical efficacy. Preliminary economic analyses further underscore the advantages of LP, demonstrating reduced wastage and lower costs compared to LTOWB, especially when partnering with a hospital system. Acknowledging the barriers in implementing prehospital blood transfusion programs due to blood supply and costs, we advocate for emergency medical service (EMS) adoption of LP, highlighting its availability, comparable efficacy to LTOWB, and cost-effectiveness. Until LTOWB becomes more accessible, LP should be prioritized in prehospital care to optimize outcomes for trauma patients in hemorrhagic shock.