The Plasma Resuscitation Early for Evaluating Volume and Endotheliopathy of Thermal Injury (PREEVEnT) trial will be a 6-year (4-year enrollment), open label, phase-3, multi-center, early in-hospital phase randomized trial utilizing burn centers from within the LITES network and will enroll approximately 750 injured adult patients who have suffered large 2nd or 3rd degree thermal burns on at least 20% of their body surface requiring burn resusciation. The objective is to determine if initiating plasma resuscitation as soon as possible upon arrival to an emergency department or burn unit is the most effective resuscitation for those who have experienced large thermal burns and significantly reduces the morbidity and mortality attributable to post-injury complications as compared to standard in-hospital resuscitation practice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
750
urgent release early plasma resuscitation following burn/thermal injury
Standard resuscitation as dictated by institutional protocol
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
28-day Mortality or Persistent Organ Dysfunction
Composite outcome consisting of 28-day all-cause mortality, or 28-day Persistent Organ Dysfunction (POD) requiring support defined as 1) any intravenous vasopressor requirement, or 2) any renal replace therapy, or 3) any ventilator support/mechanical ventilation, or 4) continued need for intensive care unit (ICU) admission at 28 days.
Time frame: 28 days
14-day mortality or Persistent Organ Dysfunction
Composite Outcome consisting of of 14-day all-cause mortality, or 14-day Persistent Organ Dysfunction requiring support (any intravenous vasopressor requirement, or any renal replace therapy, or any ventilator support, or continued need for intensive care unit (ICU) admission at 14 days)
Time frame: 14 days
Arterial or venous thromboembolism in first 7 days
Pulmonary embolism, venous thrombosis, or arterial thrombosis that occurs during the primary admission hospital stay during the first 7 days from randomization. Radiographic confirmation via CT imaging, ultrasound, duplex, transthoracic or trans-esophageal echo, or ventilation/perfusion scanning will be required. If an embolic event is unable to be verified radiographically, presumed or clinical suspicion of an embolic event will also be documented.
Time frame: 7 days
Acute respiratory distress syndrome (ARDS) in first 7 days
The Berlin definition for mild ARDS (PaO2/FIO2, ≤ 300 mmHg + timing, imaging and origin criteria) will be utilized as a threshold value to determine the incidence of ARDS
Time frame: 7 days
Abdominal compartment syndrome
Intra-abdominal hypertension requiring paralysis, and/or diagnostic peritoneal lavage, and/or decompressive laparotomy
Time frame: Enrollment through hospital discharge or 28 days
In-hospital mortality
Death prior to hospital discharge
Time frame: Enrollment through hospital discharge or 28 days
24-hour and 48-hour resuscitation
All crystalloid, colloid (albumin) and plasma resuscitation, including the utilization of vitamin C
Time frame: Enrollment through 24 hours and 48 hours
Acute kidney injury
At least one instance of a serum creatinine ≥ 1.5
Time frame: Between 24 and 72 hours from the time of randomization
Nosocomial Infection
CDC criteria for the diagnosis of hospital-acquired pneumonia and blood stream infection will be utilized
Time frame: 28 days
Ventilator-free days
Ventilator-free days will be determined by subtracting the number of ventilator days where mechanical ventilation was required utilizing an endotracheal tube or tracheostomy from 28 days. Patients undergoing operative interventions who remain on mechanical ventilation in the ICU will be considered to require ventilator support for that day.
Time frame: 28 days
ICU- free days
ICU-free days will be determined by subtracting the number of days where ICU admission was required from 28 days.
Time frame: 28 days
Allergic/transfusion reaction
Any transfusion complication during the initial 12 hours of enrollment will be documented. As the intervention is specific to the early phase of care setting and since transfusion complications are temporally related to the specific transfusion, transfusion-related complications will only be assessed during the initial 12 hours from randomization.
Time frame: Initial 12 hours from randomization
Persistent Organ Dysfunction (POD) Days
POD days will be determined based on the number of calendar days during which the patient was determined to be in POD (≥1 on total daily score), starting at day of randomization and ending at day 28.
Time frame: Starting at day of randomization and ending at day 28
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