Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air Medical Trauma Patients

Abstract

Background Hemorrhage is the leading cause of survivable death in trauma. Resuscitation strategies including early red blood cell (RBC) transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients. Study Design Retrospective cohort study of trauma patients transported by helicopter to a level-I trauma center, 2007—2012. Patients receiving PTC RBC transfusion were matched to control patients (receiving no PTC RBC transfusion during transport) in a 1:2 ratio using a propensity-score based on prehospital variables. Conditional logistic regression and mixed-effects linear regression were used to determine the association of PTC RBC transfusion with outcomes. Subgroup analysis was performed for scene transport patients. Results Two-hundred forty treatment patients were matched to 480 control patients receiving no PTC RBC transfusion. PTC RBC transfusion was associated with increased odds of 24-hour survival (adjusted odds ratio [AOR] 4.92; 95%CI 1.51, 16.04, p=0.01), lower odds of shock (AOR 0.28; 95%CI 0.09, 0.85, p=0.03), and lower 24-hour RBC requirement (Coef −3.6 RBC units; 95%CI −7.0, −0.2, p=0.04). Among matched scene patients, PTC RBC was also associated with increased odds of 24-hour survival (AOR 6.31; 95%CI 1.88, 21.14, p<0.01), lower odds of shock (AOR 0.24; 95%CI 0.07, 0.80, p=0.02), and lower 24-hour RBC requirement (Coef −4.5 RBC units; 95%CI −8.3, −0.7, p=0.02). Conclusions PTC RBC was associated with an increased probability of 24-hour survival, decreased risk of shock, and lower 24-hour RBC requirement. PTC RBC appears beneficial in severely injured air medical trauma patients and prospective study is warranted as PTC RBC transfusion becomes more readily available.

Helicopter transport improves survival following injury in the absence of a time-saving advantage

“…11–13 Our group recently demonstrated prehospital blood transfusion by HEMS providers significantly improves early outcomes for air medical trauma patients in shock. 14 Additionally, HEMS providers have greater experience with severely injured patients. As a result, HEMS providers are more familiar with managing these patients, and may confer outcome benefits similar to the volume-outcome relationship seen for trauma centers.…”

Variability of Uncrossmatched Blood Use by Helicopter EMS Programs in the United States

“…9,17,18 Only more recently has some literature suggested improved outcomes for trauma patients who receive prehospital blood transfusion. 8,19 Of those programs that independently carry a supply of blood, most programs carry blood on all flights, while fewer first assess patient cases and then decide whether to bring blood on the transport based on specific criteria. One reason for carrying blood on a patient-dependent basis could be due to local blood bank or system regulations that place a constraint on blood use on HEMS transports.…”

“…7 Some recent literature has supported improved outcomes for trauma patients who receive prehospital blood transfusion. 8 However, overall there are few reports in the literature on the use of blood transfusions during HEMS transport on a large scale, and most of the existing literature is out-ofdate and inconclusive. 3,7,9 The benefits of blood product use during air medical transport are not without their associated barriers and risks, such as the possibility of cell lysis with improper storage, the availability of properly-trained staff to administer the blood products, and the relative scarcity of O-negative blood.…”

Massive transfusion

“…In response to the need for faster treatment, recent studies have demonstrated that getting blood products to patients in the prehospital and pretrauma-center phases of trauma care could be effective in improving early outcomes and reducing incidence of shock and coagulopathy [26][27][28]. The significance of these effects, especially those of prehospital transfusion, remains to be evaluated in larger prospective trials.…”