Are on-scene blood transfusions by a helicopter emergency medical service useful and safe? A multicentre case–control study

Peters, Joost; Smulders, Pascal S. H.; Moors, Xavier R.J.; Bouman, Stef J.M.; Meijs, Claartje M.E.M.; Hoogerwerf, Nico; Edwards, Michael J.

doi:10.1097/mej.0000000000000516

Cited by 28 publications

(26 citation statements)

References 23 publications

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“…Studies comparing vital parameters in PHTRBC patients vs non‐receivers report conflicting results: significantly lower occurrence of hypotension, a higher DBP, and a higher BE and pH have been reported in PHTRBC patients, but in contrast, significantly lower SBP, a higher HR, a lower pH and a lower bicarbonate level have also been found. Other studies found no significant differences in either SBP, DBP, HR, BE, lactate, change in mean BP or in HR or occurrence of “shock on admission.” Kim et al compared PHTRBC with PHTRBC + PHT‐plasma and found no significant differences in SBP, HR, lactate, BE or pH. Brown et al measured base deficit and lactate levels on arrival to hospital, and used these to calculate the odds of shock.…”

Section: Resultsmentioning

confidence: 89%

“…However, in six other studies reporting matched or adjusted data, no significant effect on mortality was found, either at 3 hours, 6 hours, 24 hours, 28 days or 30 days post‐infusion, for in‐hospital mortality or overall mortality (Table ). Conversely, Kim et al found significantly lower mortality at 24 hours and a lower mortality overall for patients transfused with both PHT‐plasma and PHTRBC compared with patients receiving PHTRBC only.…”

Section: Resultsmentioning

confidence: 98%

“…Blunt injury was most prevalent in the included studies, ranging from 55% to 100% of trauma patients . The mean or median injury severity score (ISS) varied from 18 to 43 (Table ) . The most frequent mechanisms of injury were motor vehicle collisions (42%‐88%) and falls from a height (3.4%‐13%) …”

Section: Resultsmentioning

confidence: 99%

“…The mean or median injury severity score (ISS) varied from 18 to 43 (Table ) . The most frequent mechanisms of injury were motor vehicle collisions (42%‐88%) and falls from a height (3.4%‐13%) …”

Section: Resultsmentioning

confidence: 99%

“…In the first 24 hours after admission to hospital, civilian patients received a median of 0 to 14 U of RBC, and paediatric patients received a mean of 3.6 U …”

Section: Resultsmentioning

confidence: 99%

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Pre‐hospital transfusion of red blood cells. Part 2: A systematic review of treatment effects on outcomes

Turenhout

Bossers

Loer

et al. 2020

Transfusion Medicine

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The primary aim of this systematic review is to describe the effects of prehospital transfusion of red blood cells (PHTRBC) on patient outcomes. Damage control resuscitation attempts to prevent death through haemorrhage in trauma patients. In this context, transfusion of red blood cells is increasingly used by emergency medical services (EMS). However, evidence on the effects on outcomes is scarce. PubMed and Web of Science were searched through January 2019; 55 articles were included. No randomised controlled studies were identified. While several observational studies suggest an increased survival after PHTRBC, consistent evidence for beneficial effects of PHTRBC on survival was not found. PHTRBC appears to improve haemodynamic parameters, but there is no evidence that shock on arrival to hospital is averted, nor of an association with trauma induced coagulopathy or with length of stay in hospitals or intensive care units. In conclusion, PHTRBC is increasingly used by EMS, but there is no strong evidence for effects of PHTRBC on mortality. Further research with study designs that allow causal inferences is required for more conclusive evidence. The combination of PHTRBC with plasma, as well as the use of individualised transfusion criteria, may potentially show more benefits and should be thoroughly investigated in the future. The review was registered at Prospero (CRD42018084658). K E Y W O R D Sdamage control resuscitation, emergency medical service, major haemorrhage, mortality, outcome, prehospital transfusion, red blood cells

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…In the first 24 hours after admission to hospital, civilian patients received a median of 0 to 14 U of RBC, and paediatric patients received a mean of 3.6 U …”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Pre‐hospital transfusion of red blood cells. Part 2: A systematic review of treatment effects on outcomes

Turenhout

Bossers

Loer

et al. 2020

Transfusion Medicine

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Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes

et al. 2020

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IMPORTANCE Both military and civilian clinical practice guidelines include early plasma transfusion to achieve a plasma to red cell ratio approaching 1:1 to 1:2. However, it was not known how early plasma should be given for optimal benefit. Two recent randomized clinical trials were published, with apparently contradictory results. The Prehospital Air Medical Plasma (PAMPer) clinical trial showed a nearly 30% reduction in mortality with plasma transfusion in the prehospital environment, while the Control of Major Bleeding After Trauma (COMBAT) clinical trial showed no survival improvement.OBJECTIVE To facilitate a post hoc combined analysis of the COMBAT and PAMPer trials to examine questions that could not be answered by either clinical trial alone. We hypothesized that prehospital transport time influenced the effects of prehospital plasma on 28-day mortality.DESIGN, SETTING, AND PARTICIPANTS A total of 626 patients in the 2 clinical trials were included. Patients with trauma and hemorrhagic shock were randomly assigned to receive either standard care or 2 U of thawed plasma followed by standard care in the prehospital environment. Data analysis was performed between September 2018 and January 2019.INTERVENTIONS Prehospital transfusion of 2 U of plasma compared with crystalloid-based resuscitation. MAIN OUTCOMES AND MEASURESThe main outcome was 28-day mortality. RESULTSIn this post hoc analysis of 626 patients (467 men [74.6%] and 159 women [25.4%]; median [interquartile range] age, 42 [27-57] years) who had trauma with hemorrhagic shock, a Cox regression analysis showed a significant overall survival benefit for plasma (hazard ratio [HR], 0.65; 95% CI, 0.47-0.90; P = .01) after adjustment for injury severity, age, and clinical trial cohort (COMBAT or PAMPer). A significant association with prehospital transport time was detected (from arrival on scene to arrival at the trauma center). Increased mortality was observed in patients in the standard care group when prehospital transport was longer than 20 minutes (HR, 2.12; 95% CI, 1.05-4.30; P = .04), while increased mortality was not observed in patients in the prehospital plasma group (HR, 0.78; 95% CI, 0.40-1.51; P = .46). No serious adverse events were associated with prehospital plasma transfusion.CONCLUSIONS AND RELEVANCE These data suggest that prehospital plasma is associated with a survival benefit when transport times are longer than 20 minutes and that the benefit-risk ratio is favorable for use of prehospital plasma.

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Dried Plasma for Trauma Resuscitation

Weiskopf

2020

Trauma Induced Coagulopathy

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Are on-scene blood transfusions by a helicopter emergency medical service useful and safe? A multicentre case–control study

Cited by 28 publications

References 23 publications

Pre‐hospital transfusion of red blood cells. Part 2: A systematic review of treatment effects on outcomes

Pre‐hospital transfusion of red blood cells. Part 2: A systematic review of treatment effects on outcomes

Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes

Dried Plasma for Trauma Resuscitation

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