BackgroundEarly transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery.MethodsThe decision to administer a pre-hospital PRBC transfusion was based on clinical judgment. All patients transfused pre-hospital PRBC between February 2013 and December 2014 were included. Pre-hospital and in-hospital records were retrospectively reviewed.ResultsOne hundred forty-seven patients were included. 142 patients had traumatic injuries and 5 patients had haemorrhagic shock from a medical origin. Median Injury Severity Score was 30. 90% of patients receiving PRBC had an ISS of >15. Patients received a mean of 2.4(±1.1) units of PRBC in the pre-hospital phase. Median time from initial emergency call to hospital arrival was 114 min (IQR 103–140). There was significant improvement in systolic (p < 0.001), diastolic (p < 0.001) and mean arterial pressures (p < 0.001) with PRBC transfusion but there was no difference in HR (p = 0.961). Patients received PRBC significantly faster in the field than waiting until hospital arrival. At the receiving hospital 57% required an urgent surgical or interventional radiology procedure. At hospital arrival, patients had a mean lactate of 5.4(±4.4) mmol/L, pH of 6.9(±1.3) and base deficit of −8.1(±6.7). Mean initial serum adjusted calcium was 2.26(±0.29) mmol/L. 89% received further blood products in hospital. No transfusion complications or significant incidents occurred and 100% traceability was achieved.DiscussionPre-hospital transfusion of packed red cells has the potential to improvde outcome for trauma patients with major haemorrhage. The pre-hospital time for trauma patients can be several hours, suggesting transfusion needs to start in the pre-hospital phase. Hospital transfusion research suggests a 1:1 ratio of packed red blood cells to plasma improves outcome and further research into pre-hospital adoption of this strategy is needed.ConclusionPre-hospital PRBC transfusion significantly reduces the time to transfusion for major trauma patients with suspected major haemorrhage. The majority of patients receiving pre-hospital PRBC were severely injured and required further transfusion in hospital. Further research is warranted to determine which patients are most likely to have outcome benefit from pre-hospital blood products and what triggers should be used for pre-hospital transfusion.

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The 9 th London Trauma Conference (#LTC2015) and London Cardiac Arrest Symposium (#LCAS2015) built on the previous meetings with an emphasis on innovation, research, and enthusiasm for the medical care of major trauma, cardiac and critically ill patients. From the 8-11th December 2015 delegates from over 20 countries attended The Royal Geographical Society for the four days of the conference. The opening two days of the conference focussed on current issues in major trauma, with air ambulance and pre-hospital critical care on day three, and the London cardiac arrest symposium returning as the fourth and final day. Concurrent breakaway sessions ran alongside the main conference including; trauma haemorrhage research, paediatric trauma, and masterclasses on cardiac ultrasound and resuscitation, thoracotomy, REBOA, and an introduction to ECLS and ECMO. The major trauma programme consisted of two days of lectures, keynote lectures and short 'quickfire' sessions. Professor Tim Coats opened the conference by talking about the role of the highly performing trauma unit in trauma networks -outlining the problems of maintaining high levels of care in systems which increasingly bypass to major trauma centres but bring severely injured irregularly to trauma units. Professor Kjetil Søreide then addressed the topic of iatrogenesis in trauma, giving examples from different points in the patient pathway. The prevention of iatrogenesis is based on acceptance of it's presence and then promoting prevention with a culture of safety, training and focus on the team approach. Dr Matt Thomas finished up by summarising the landscape of research in trauma over the previous year, as well as outlining what can be expected in the year ahead. The following sessions approached key issues in neurotrauma, opened by a seasoned London Trauma Conference speaker Mr Mark Wilson. He spoke on current early neurological imaging, with mobile CT scanning already a reality in mainland Europe and the trialling of near infrared spectroscopy (NIRS) as a potential pre-hospital imaging modality. Professor Geoffrey Raisman followed with a fascinating talk on spinal cord regeneration, outlining how nerve regeneration to replace damaged portions has already been trialled with some success. He related a moving case where olfactory nerve fibres were used to repair spinal cord injury with one of the ultimate medical triumphs -making a paraplegic patient walk again. Professor Andrew Maas then lectured expertly on why he sees head injury as a silent epidemic with potentially life-changing consequences. Dr Markus Skrifvars closed the session with a sobering presentation on the link between alcohol consumption and the vast number of traumatic brain-injured patients that are intoxicated when they present. Lunch was followed by Professor Karim Brohi, who delivered a talk on the early immune response to trauma and novel potential approaches to ameliorate this genomic storm. Other speakers in the afternoon included Professor Marc Turner delivering his vision for the trauma ...

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