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The COVID-19 pandemic has had a significant impact on trauma patients, particularly in terms of blood shortages. This has resulted in changes in the types of injuries seen and an increased need for transfusions. However, there has been difficulty in meeting the demand for blood products, including red blood cells, platelets, cryoprecipitate, and plasma. Blood donation has also decreased during the pandemic, exacerbating the shortage. To address these challenges, strategies such as adjusting transfusion ratios and implementing walking blood banks have been considered. The shortage of blood supply has had significant implications for the management of trauma patients, leading to higher mortality rates and longer hospital stays for COVID-19 positive patients. Ethical considerations have also arisen, including determining criteria for futility in trauma resuscitation and the allocation of blood resources. Trauma surgeons play a crucial role in advocating for patients and making complex decisions regarding blood management. Efforts are needed to recover from the blood shortage and better prepare for future disaster situations. [Extracted from the article]

Keywords: acute respiratory distress syndrome; COVID convalescent plasmaCOVID-19endotheliopathy of COVID-19plasmaSARS-CoV-2 EN acute respiratory distress syndrome COVID convalescent plasmaCOVID-19endotheliopathy of COVID-19plasmaSARS-CoV-2 S336 S347 12 07/19/21 20210702 NES 210702 BACKGROUND The novel coronavirus SARS-CoV-2, which causes COVID-19, surfaced in late 2019, and by mid-March 2020 it had been declared a formal pandemic producing a worldwide crisis.1 The global death toll climbed to above 6000 by March 15, 2020, just a few days after a national emergency was declared in the United States. Although CCP has not proven to be effective in treating advanced severe cases of COVID-19, what has emerged from trials with CCP is that plasma transfusion in these critically ill COVID-19 patients does not appear to be deleterious or harmful and to lead to increased thromboses, which has been a concern considering the hyperthrombotic state of COVID-19 patients. The rate of SAEs definitely related to transfusion of CCP was objectively low ( I n i = 2), hence supporting the safety of plasma transfusion in COVID-19 patients receiving 1-2 units.36 These data support the safety of plasma transfusions in COVID-19 patients. This has yet to be elucidated in COVID patients and, considering that there are indeed reports of a "cytokine storm" and long-term consequences of the disease (i.e., COVID-19 long haulers), the ex-COVID-19 patients' "normal" plasma could potentially be unsuitable for transfusion months or even years later. [Extracted from the article]

As with all areas of medicine, high-quality clinical research is essential to improving the care of trauma patients. This research is crucial in developing evidence-based treatments that decrease cost, decrease morbidity, and improve mortality. Trauma continues to extract a significant toll on society and is the single largest cause of years of life lost in the United States. The need to conduct high-quality clinical research in trauma is not disputed. However, significant challenges and barriers unique to the field of trauma make performing this research more difficult. It is critical to be aware of these challenges and barriers to performing clinical research involving trauma patients so these challenges can be accounted for and solutions implemented to minimize their impact on research. This review will focus on the barriers and challenges that are encountered while performing clinical research in trauma. [ABSTRACT FROM AUTHOR]

The early transfusion of plasma is important to ensure optimal survival of patients with traumatic hemorrhage. In military and remote or austere civilian settings, it may be impossible to move patients to hospital facilities within the first few hours of injury. A dried plasma product with reduced logistical requirements is needed to enable plasma transfusion where medically needed, instead of only where freezers and other equipment are available. First developed in the 1930s, pooled lyophilized plasma was widely used by British and American forces in WWII and the Korean War. Historical dried plasma products solved the logistical problem but were abandoned because of disease transmission. Modern methods to improve blood safety have made it possible to produce safe and effective dried plasma. Dried plasma products are available in France, Germany, South Africa, and a limited number of other countries. However, no product is available in the US. Promising products are in development that employ different methods of drying, pathogen reduction, pooling, packaging, and other approaches. Although challenges exist, the in vitro and in vivo data suggest that these products have great potential to be safe and effective. The history, state of the science, and recent developments in dried plasma are reviewed. [ABSTRACT FROM AUTHOR]

Background: Although a majority of the studies conducted to date on platelet (PLT) storage have been focused on PLT hemostatic function, the effects of 4°C PLTs on regulation of endothelial barrier permeability are still not known. In this study, we compared the effects of room temperature (22°C) stored and (4°C) stored PLTs on the regulation of vascular endothelial cell (EC) permeability in vitro and in vivo.Study Design and Methods: Day 1, Day 5, and Day 7 leukoreduced apheresis PLTs stored at 4 or 22°C were studied in vitro and in vivo. In vitro, PLT effects on EC permeability and barrier function, adhesion, and impedance aggregometry were investigated. In vivo, using a mouse model of vascular leak, attenuation of vascular leak and circulating PLT numbers were measured.Results: Treatment of EC monolayers with Day 5 or Day 7 PLTs, stored at both 22°C and 4°C, resulted in similar decreases in EC permeability on average. However, analysis of individual samples revealed significant variation that was donor dependent. Additional in vitro measurements revealed a decrease in inflammatory mediators, nonspecific PLT-endothelial aggregation and attenuated loss of aggregation over time to TRAP, ASPI, ADP, and collagen with 4°C storage. In mice, while 22°C and 4°C PLTs both demonstrated significant protection against vascular endothelial growth factor A (VEGF-A)-induced vascular leak 22°C PLTs exhibited increased protection compared to 4°C PLTs. Systemic circulating levels of 4°C PLTs were decreased compared to 22°C PLTs.Conclusions: In vitro, 4°C-stored PLTs exhibit a greater capacity to inhibit EC permeability than 22°C-stored PLTs. In vivo, 22°C PLTs provide superior control of vascular leak induced by VEGF-A. This discrepancy may be due to increased clearance of 4°C PLTs from the systemic circulation. [ABSTRACT FROM AUTHOR]

Background: In current blood banking practices, platelets (PLTs) are stored in plasma at 22°C, with gentle agitation for up to 5 days. To date, the effects of storage and donor variability on PLT regulation of vascular integrity are not known. Study Design and Methods: In this study, we examined the donor variability of leukoreduced fresh (Day 1) or stored (Day 5) PLTs on vascular endothelial barrier function in vitro and in vivo. In vitro, PLT effects on endothelial cell (EC) monolayer permeability were assessed by analyzing transendothelial electrical resistances (TEER). PLT aggregation, a measure of hemostatic potential, was analyzed by impedance aggregometry. In vivo, PLTs were investigated in a vascular endothelial growth factor A (VEGF-A)-induced vascular permeability model in NSG mice, and PLT circulation was measured by flow cytometry. Results: Treatment of endothelial monolayers with fresh Day 1 PLTs resulted in an increase in EC barrier resistance and decreased permeability in a dose-dependent manner. Subsequent treatment of EC monolayers with Day 5 PLTs demonstrated diminished vasculoprotective effects. Donor variability was noted in all measures of PLT function. Day 1 PLT donors were more variable in their effects on TEER than Day 5 PLTs. In mice, while all PLTs regardless of storage time demonstrated significant protection against VEGF-A-induced vascular leakage, Day 5 PLTs exhibited reduced protection when compared to Day 1 PLTs. Day 1 PLTs demonstrated significant donor variability against VEGF-A-challenged vascular leakage in vivo. Systemic circulating levels of Day 1 PLTs were higher than those of Day 5 PLTs Conclusions: In vitro and in vivo, Day 1 PLTs are protective in measures of vascular endothelial permeability. Donor variability is most prominent in Day 1 PLTs. A decrease in the protective effects is found with storage of the PLT units between Day 1 and Day 5 at 22°C, thereby suggesting that Day 5 PLTs are diminished in their ability to attenuate vascular endothelial permeability. [ABSTRACT FROM AUTHOR]