Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland

Background Major bleeding is the leading cause of preventable mortality among trauma patients. Several studies have recently shown that prehospital plasma transfusion improves the outcomes of severely injured patients. Although no consensus has been reached, prehospital transfusion is regularly considered to reduce avoidable mortality. The objective was to assess the status of prehospital transfusion practices in France. Study Design and Methods A national survey among the 378 advance life support emergency teams (SMURs) in metropolitan France was conducted from December 15, 2020 to October 31, 2021. A questionnaire was distributed by e‐mail to the physicians in charge of SMURs. The questions addressed the transfusion modalities, labile blood products (LBPs) used, and limitations encountered in implementing transfusion. Results The response rate was 48%, and 82% of the respondents performed prehospital transfusions. A designated pack was used by 44% of the respondents. The LBPs used were packed red blood cells (100%), of which 95% were group 0 RH:‐1, fresh frozen plasma (27%), lyophilized plasma (7%), and platelets (1%). The LBPs were transported in isothermal boxes (97%) without temperature monitoring in 52% of the cases. Nontransfused LBPs were discarded in 43% of the cases. Reported limitations in implementing transfusion were the delivery time (45%), loss of LBPs (32%), and lack of evidence (46%). Discussion Prehospital transfusion was developed in France but access to plasma remains difficult. Protocols allowing the reutilization of LBPs and improving conservation could limit the waste of a rare resource. Implementing the use of lyophilized plasma could facilitate prehospital transfusion. Future studies will need to specify the role of each LBP in the prehospital setting.

Section: Discussionsupporting

confidence: 80%

“…However, medical pathologies are the first causes of PHT according to our results, which is confirmed by the few European practice studies available. 38,39 Data are poor for these PHT indications.…”

Section: Discussionmentioning

confidence: 99%

Use of prehospital transfusion by French emergency medical services: A national survey

Bichot

Pasquier²,

Martinaud

et al. 2023

“…In Finnish studies of prehospital blood product recipients, the short-term mortality rate has been reported to be 18%-33%. [33][34][35] Taken together, we are likely to overestimate the potential for RhD alloimmunization and the true alloimmunization rate would probably be lower than the calculated one.…”

Section: Discussionmentioning

confidence: 74%

Low titer group O whole blood and risk of RhD alloimmunization: Rationale for use in Finland

Susila,

Ilmakunnas,

Lauronen

et al. 2024

BackgroundPrehospital low‐titer group O whole blood (LTOWB) used for patients with life‐threatening hemorrhage is often RhD positive. The most important complication following RhD alloimmunization is hemolytic disease of the fetus and newborn (HDFN). Preceding clinical use of RhD positive LTOWB, we estimated the risk of HDFN due to LTOWB prehospital transfusion in the Finnish population.Study Design and MethodsWe collected data on prehospital transfusions in Tampere and Helsinki University Hospital areas. Using the mean of reported alloimmunization rates in trauma studies (24%) and a higher reported rate representing trauma patients of 13–50 years old (42.7%), we estimated the risk of HDFN and extrapolated it to the whole of Finland.ResultsWe estimated that in Finland, with the current prehospital transfusion rate we would see 1–3 cases of severe HDFN due to prehospital LTOWB transfusions every 10 years, and fetal death due to HDFN caused by LTOWB transfusion less than once in 100 years.DiscussionThe estimated risk of serious HDFN due to prehospital LTOWB transfusion in the Finnish population is similar to previous estimates. As Finland routinely screens expectant mothers for red blood cell antibodies and as the contemporary treatment of HDFN is very effective, we support the prehospital use of RhD positive LTOWB in all patient groups.

“…18 Recent data from our rural emergency medical service (EMS) area showed that PHBT was started a median of 61 min before admission. 19 We have estimated that 100-125 patients per year are transfused with blood products during prehospital care in Finland. 20 Of them, 23%-44% are also nontrauma patients (e.g., gastrointestinal bleeding, obstetric, or vascular emergencies).…”

Section: Introductionmentioning

confidence: 99%

“…20 Of them, 23%-44% are also nontrauma patients (e.g., gastrointestinal bleeding, obstetric, or vascular emergencies). 18,19,21 In this study, we retrospectively analyzed all adult (age ≥16 years) blunt trauma patients with new injury severity score (NISS) >15 treated by a P-S PHEC unit from the Helsinki Trauma Registry (HTR) with PHBT capability between Mach 2016 and July 2021. Our aim was to identify factors affecting the decision to start PHBT at the site of an accident.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting physicians' decision to start prehospital blood product transfusion in blunt trauma patients: A cohort study of Helsinki Trauma Registry

Jama,

Lefering,

Lauronen

et al. 2024

Self Cite

BackgroundPrehospital blood transfusions are increasing as a treatment for bleeding trauma patients at risk for exsanguination. Triggers for starting transfusion in the field are less studied. We analyzed the factors affecting the decision of physicians to start prehospital blood product transfusion (PHBT) in blunt adult trauma patients.Study Design and MethodsData of all adult blunt trauma patients from the Helsinki Trauma Registry between March 2016 and July 2021 were retrospectively analyzed. Univariate analysis for the identification of predictive factors and multivariate regression analysis for their importance as predictive factors for the initiation of PHBT were applied.ResultsThere were 1652 patients registered in the database. A total of 556 of them were treated by a physician‐level prehospital emergency care unit, of which by transfusion‐capable unit in 394 patients. PHBT (red blood cells and/or plasma) was started in 19.8% of the patients. We identified three statistically highly important clinical triggers for starting PHBT: high crystalloid volume need, shock index ≥0.9, and need for prehospital pleural decompression.DiscussionPHBT in blunt adult trauma patients is initiated in ~20% of the patients in Southern Finland. High crystalloid volume need, shock index ≥0.9 and prehospital pleural decompression are associated with the initiation of PHBT, probably reflecting patients at high risk for bleeding.