Implementation of a pre‐hospital transfusion service in Latin America: the pioneering experience of a Brazilian centre

Abstract

Background and Objectives This report describes the implementation of the first pre‐hospital transfusion service in Latin America, with red blood cell concentrates available for immediate use in mobile land units. Materials and Methods A partnership was established between the Regional Mobile Emergency Service and the Regional Blood Bank, with further development of protocols for the storage, transportation and transfusion of red blood cell concentrates in an ambulance, with the acquisition of special thermal boxes, a heater for blood components and digital thermometers. Results The Service was developed from May 2019 and implemented in September 2020, in a mobile intensive care unit serving 11 cities, reaching a population of approximately 480 000 inhabitants. Two red blood cell concentrates, type ‘O’ RhD negative, are available, stored in a special sealed thermal box and with continuous temperature monitoring. A specific transfusion protocol was developed, in accordance with the institutional protocols of the Hospital and its Blood Bank. Conclusion This is the first description of a pre‐hospital transfusion service implemented in Latin America, with the potential to reduce the number of deaths from civil trauma and which can be extrapolated to other institutions or countries in similar conditions.

First immediate transfusion at a prehospital environment in Latin America: A case report

“…Trauma is the main cause of death and disability in people from 1 to 44 years, both in Brazil and in other Latin American countries. 3 , 4 In 2017, the Global Burden of Diseases (GBD) estimated that death by trauma represented 8% of the global mortality, with a rate of 57,9 deaths per 100.000 inhabitants, 5 being bleeding and hemorrhagic shock the cause of 30 to 40% of those preventable deaths, 6 resulting in approximately 75 million years of life lost. 7 Therefore, hemorrhagic control and shock stabilization are essential for the prevention of those deaths.…”

“… 11 , 12 In Brazil, prehospital blood transfusion was established in September 2020, at a mobile intensive care unit (SAMU 192) in Bragança Paulista, a city in the inner part of the state of São Paulo, being the first in Latin America to offer this kind of procedure. 4 …”

“… 13 In this context, the criteria used in the service to perform the transfusion was developed by the unit itself, shown in Figure 3 , in summary: traumatized adult patients (traumatic cardiorespiratory arrest, firearm injury, stab wound, piercing-cutting wound, polytrauma), or with upper or lower gastrointestinal bleeding or those with puerperal bleeding and hemorrhagic shock, who meet at least 2 out of 4 ABC Score criteria for trauma, presence of signs of hemodynamic instability, shock index > 1 or pulse pressure < 45. 4

Figure 3 Criteria for indicating prehospital transfusion in this protocol.

…”