Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service

Sunde, Geir Arne; Bjerkvig, Christopher; Bekkevold, Marit; Kristoffersen, Einar K.; Strandenes, Geir; Bruserud, Øyvind; Apelseth, Torunn Oveland; Heltne, Jon-Kenneth

doi:10.1186/s13049-022-01051-z

Cited by 13 publications

(14 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We identified 17 studies reporting about patients with traumatic hemorrhage treated with at least 1 unit WB (without BCT comparison) including 10 retrospective cohort studies, 4 case series, and 3 prospective observational studies 12,14,58–72 . All studies are summarized in Supplementary Digital Content 13, http://links.lww.com/TA/D6.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Horst

Rijnhout

Noorman³

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND Whole blood (WB) transfusion received renewed interest after recent armed conflicts. The effectiveness as compared with blood component transfusion (BCT) is, however, still topic of debate. Therefore, this study investigated the effect of WB ± BCT as compared with BCT transfusion on survival in trauma patients with acute hemorrhage. METHODS Studies published up to January 16, 2023, including patients with traumatic hemorrhage comparing WB ± BCT and BCT were included in meta-analysis. Subanalyses were performed on the effectiveness of WB in the treatment of civilian or military trauma patients, patients with massive hemorrhage and on platelet (PLT)/red blood cell (RBC), plasma/RBC and WB/RBC ratios. Methodological quality of studies was interpreted using the Cochrane risk of bias tool. The study protocol was registered in PROSPERO under number CRD42022296900. RESULTS Random effect pooled odds ratio (OR) for 24 hours mortality in civilian and military patients treated with WB as compared with BCT was 0.72 (95% confidence interval [CI], 0.53–0.97). In subanalysis of studies conducted in civilian setting (n = 20), early (4 hours, 6 hours, and emergency department) and 24 hours mortality was lower in WB groups compared with BCT groups (OR, 0.65; 95% CI, 0.44–0.96 and OR, 0.71; 95% CI, 0.52–0.98). No difference in late mortality (28 days, 30 days, in-hospital) was found. In military settings (n = 7), there was no difference in early, 24 hours, or late mortality between groups. The WB groups received significant higher PLT/RBC (p = 0.030) during early treatment and significant higher PLT/RBC and plasma/RBC ratios during 24 hours of treatment (p = 0.031 and p = 0.007). The overall risk of bias in the majority of studies was judged as serious due to serious risk on confounding and selection bias, and unclear information regarding cointerventions. CONCLUSION Civilian trauma patients with acute traumatic hemorrhage treated with WB ± BCT as compared to BCT had lower odds on early and 24-hour mortality. In addition, WB transfusion resulted in higher PLT/RBC and plasma/RBC ratios. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level III.

show abstract

Section: Resultsmentioning

confidence: 99%

“…In brief, included studies reported that WB transfusion is feasible in both military medicine, 62,68 and civilian medicine, 12,70,71 including in the prehospital setting. 72 Also, studies indicate WB transfusion is safe, 14,61,65,66,69 even in very large quantities up to 68 units WB. 64,67…”

Section: Wb Transfusion Without Bct Comparisonmentioning

confidence: 99%

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Horst

Rijnhout

Noorman³

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Although currently limited, our experience with LTOWB comes at a crucial time in the debate over prehospital utilisation of blood products. The benefits of whole blood (albeitfresh whole blood), demonstrated in several observational studies, 29,30 along with its increased utilisation in civilian settings [9][10][11]17 have raised the prospects of deploying whole blood in the prehospital military setting. The recently published RePHILL 31 trial, has brought into question the benefits of prehospital PRBC and plasma.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the current evidence on the benefits and safety of whole blood, 9,10,17,22,23,29,[32][33][34] we chose to implement its use in the prehospital setting, with the aim of continuing to evaluate our data along with growing evidence on its use.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 However, the use of LTOWB in prehospital settings is met with significant deployment and logistic challenges, and has therefore been used in limited settings, primarily among helicopter emergency medical services. 17,18 In October 2017, the American Association of Blood Banks (AABB) 19 approved the use of whole blood as a standard product for patients with severe bleeding, but its use in ground ambulances has remained very limited. 20,21 The use of blood products in the prehospital setting has become a fundamental part of remote damage-control resuscitation (RDCR), considering the potential benefit of their use close to the point-ofinjury.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Low‐titer group O whole blood in military ground ambulances: Lessons from the Israel Defense Forces initial experience

Talmy,

Malkin,

Esterson

et al. 2023

Transfusion Medicine

View full text Add to dashboard Cite

BackgroundCold‐stored low‐titer group O whole blood (LTOWB) has become increasingly utilised in both prehospital and in‐hospital settings for resuscitation of traumatic haemorrhage. However, implementing the use of LTOWB to ground medical teams has been limited due to logistic challenges.MethodsIn 2022, the Israel Defense Forces (IDF) started using LTOWB in ambulances for the first time in Israel. This report details the initial experience of this rollout and presents a case‐series of the first patients treated with LTOWB.ResultsBetween January–December 2022, seven trauma patients received LTOWB administered by ground IDF intensive care ambulances after presenting with profound shock. Median time from injury to administration of LTOWB was 35 min. All patients had evidence of severe bleeding upon hospital arrival with six undergoing damage control laparotomy and all but one surviving to discharge.ConclusionsThe implementation of LTOWB in ground medical units is in its early stages, but continued experience may demonstrate its feasibility, safety, and effectiveness in the prehospital setting. Further research is necessary to fully understand the indications, methodology, and benefits of LTOWB in resuscitating severely injured trauma patients in this setting.

show abstract

Prähospitale Bluttransfusion

Schwietring,

Wähnert,

Scholl

et al. 2024

Anaesthesiologie

View full text Add to dashboard Cite

Zusammenfassung Hintergrund Blutverlust ist die Hauptursache potenziell vermeidbarer Todesfälle bei schweren Verletzungen. Behandlungsprioritäten sind die sofortige Kontrolle der Blutung und die Transfusion von Blutprodukten zur Aufrechterhaltung des Sauerstofftransports und zur Therapie der traumainduzierten Koagulopathie. Während die prähospitale Transfusion von Blutprodukten (PHBT) in unseren Nachbarländern etabliert ist, hat die fragmentierte Struktur der Rettungsdienste die Einführung von PHBT-Programmen in Deutschland verzögert. Unsere Arbeit bietet eine aktuelle Perspektive auf die Entwicklung, internationale Praktiken und den Forschungsbedarf zur Anwendung von PHBT im deutschen Kontext. Methodik Diese narrative Übersicht basiert auf einer PubMed-Suche mit den Schlüsselwörtern „prehospital“ und „blood*“. Von 4738 gefundenen Artikeln bezogen sich 333 auf PHBT und wurden einer weiteren detaillierten Sichtung unterzogen. Die Literatur, einschließlich zitierter Studien, wurde in Bereiche wie Geschichte, Rationale, internationale Praktiken und Evidenz kategorisiert und entsprechend ihrer Qualität in die Auswertung einbezogen. Ergebnisse Der Nutzen der frühzeitigen Bluttransfusion bei schwerem Trauma ist seit dem Ersten Weltkrieg belegt, was die Bestrebungen erklärt, diese lebensrettende Maßnahme schon im prähospitalen Bereich einzuleiten. Neuere randomisierte Studien, die aufgrund der komplexen Fragestellung mit Design- und Rekrutierungsproblemen kämpften, haben widersprüchliche Ergebnisse hinsichtlich des Überlebensvorteils im zivilen Bereich geliefert. Die Lehren aus diesen Arbeiten lassen bezweifeln, ob randomisierte Studien tatsächlich in der Lage sind, Fragen zum Überlebensvorteil zu klären. Trotz der genannten Schwierigkeiten gibt es einen erkennbaren Trend, der bei transfundierten Patienten auf Verbesserungen des Outcome hindeutet. In Deutschland beträgt die Inzidenz des traumaassoziierten Schocks 38/100.000 Einwohner pro Jahr. Geschätzt wird, dass zwischen 300 und 1800 Patienten jährlich von PHBT profitieren könnten. Schlussfolgerungen Die prähospitale Gabe von Blutprodukten erscheint vielversprechend, doch bleibt offen, welche Patientengruppen davon profitieren und welche Blutprodukte am besten geeignet sind. In Deutschland sind PHBT-Programme noch nicht weit verbreitet. Paradoxerweise bietet diese Situation, zusammen mit dem umfangreichen Trauma Register der Deutschen Gesellschaft für Unfallchirurgie, eine hervorragende Ausgangssituation für umfassende prospektive Kohortenstudien, um Patienten-Outcome, Logistik und Implementierungsstrategien zu untersuchen. Solche Studien könnten helfen, evidenzbasierte PHBT-Richtlinien auszuarbeiten und in deutsche Traumaversorgungsprotokolle zu integrieren.

show abstract

Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service

Cited by 13 publications

References 40 publications

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Low‐titer group O whole blood in military ground ambulances: Lessons from the Israel Defense Forces initial experience

Prähospitale Bluttransfusion

Contact Info

Product

Resources

About