Thread by @J_Stensballe

Trying my best to understand the results of the very important @RePHILL_trial : Excellent work and fab collaboration studying very complex pts in difficult circumstances #WellDoneAll #Congrats
thelancet.com/journals/lanha…
1/9 on my take….

Result are contradictory to current evidense (RCT and non-RCT) and our understanding of the patophysiology of trauma haemorrhage 2/9 #Limitation #GoAgainstTheFlow #NotRight ?

Trial underpowered ? Power calc reduction 20 - 10 % in PE is a little bold maybe + too many factors affecting the PE. #StatisticalAnalysisPlan reconsidered ?
3/9

#LactateClearence as a endpoint in bleeding is challenging ? We are clinically concerned when pts dont clear lactate, but not the other way around in bleeding. Finding and #StopTheBleeding is still the key priority
4/9

#Timing of intervention at median 1 h after injury (30 min on scene before intervention) and then arriving 20 min later at hospital #TooLate ?
First 430 mL NaCl in, then 443 mL PRBC / 266 mL LyoPlas #CrytalloidsFirst and then #TooLittle #TooLate ? #TooLongSceneTime ?
5/9

#MoreBleeding in the RBC/Lyo group do not make any sence to me. Significant more RBC and FFP transfusion at 24 h in the RBC/Lyo arm ? Sign less crystalloid 24 h in the NaCl group. #Why ? #Skewed ? #Confiunding ? #Bias ?
6/9

#ToSickTooBenifit ? ISS 36 IQR 25-50 if there is a therapeutic window ? High mortality 16 vs 22% at 3 h (RBC/Lyo vs NaCl), 42 vs 45 at 30-d #HigherThanExpected ?
7/9

Too much #Resuscitation? Is this actually #rDCR ? Normotensive on ED arrival BP115/74, over- resuscitation ? #TooMuch ? #TooLate
8/9

What is the the conclusion ? Hmmm🧐🤨 #ClinicalImpact ? Yeah for sure let”s stay w #PlasmaFirst acc to #PAMPer and #COMBAT results showing survival benifit (n=628 vs 432 in #Rephill) #PlasmaFirst way forward waiting for #ColdStoredWholeBlood trials #IMHO
9/9

journals.lww.com/journalacs/ful…