Pre-hospital blood transfusion – an ESA survey of European practice

Abstract

Background Blood products are a lifesaving commodity in the treatment of major trauma. Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage. The primary aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The secondary aim was to evaluate opinions about PHBP and also the experience and the personal views of its users. Methods The subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d’Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries. Results In total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37 and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%. Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently. Conclusions We found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.

Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

“…It is also the most current published survey of pre-hospital transfusion practice in the UK, and highlights the range of pre-hospital transfusion strategies. This regional heterogeneity is consistent amongst both historical studies 24 , and contemporary surveys of European practice 25 but also demonstrates the rapid development in blood product availability pre-hospital within the UK, the US, Scandinavia and Europe within the intervening four years, and the continuing lack of consensus regarding the bene ts of pre-hospital blood product transfusion, which blood components should be transfused, and at what point in the patient pathway. The variation may, in part, be due to lack of clear, high-level pre-hospital evidence for any one transfusion strategy.…”

Präklinische Therapie mit Blutprodukten – das Projekt „HeliBlut“

“…Aufgrund des potenziellen Nutzens wurde die prähospitale Transfusion in zahlreichen Rettungsdiensten eingeführt [29,30].…”

Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

“…A followup systematic review of 16 randomized controlled trials (RCTs) stated similar concerns regarding the recommendations of the PROPPR trial. Given the diversity of patients with blunt or penetrating trauma and with or without TBI, additional studies are required to determine the mortality benefit of 1:1:1 vs. 1:1:2 fixed ratios [12,15,16]. Due to the concerns about the validity of the PROPPR trial, which set the standard for the fixed 1:1:1 practice, we review the reasons for the widespread adoption of CSWB in the United States for civilian urban trauma.…”

“…Germany, with its centralized system and relatively short transport times, uses prehospital blood products in 6% of trauma centers. Comparatively in France, the rate is 89% [16]. It is not surprising that the only European RCT for using CSWB in the civilian urban population is in France, where the time spent in the field on resuscitation efforts is longer than the "scoop and run" strategy used in the United States, where physicians are not onboard ambulances [107].…”

“…However, the European Society of Anesthesiology recently reported that 48% of responders to an online survey had access to PRBCs, 22% to fresh plasma, and 14% to lyophilized plasma [16]. It is clear that there were significant dissimilarities in practice among European countries with no consensus regarding the benefit of prehospital blood products [16]. Hence, there is a tremendous need for continued investigation in RCTs.…”