Prehospital blood transfusion: Advances and interests in tactical medicine

Corcostegui, Simon-Pierre; David, Mathieu; Galant, Julien; Martinaud, Christophe; Travers, Stéphane; Retail, Cédric Boutillier du

doi:10.1016/j.accpm.2021.100911

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…19 Transfusion can be started while driving, following the military enroute care strategy. 20 Our procedure seems cumbersome, since prehospital transfusion programs aboard land or air ambulances have existed in many countries for several years. 21,22 France has among the most stringent legislation on transfusion policy and hemovigilance.…”

Section: Resultsmentioning

confidence: 99%

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Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

et al. 2023

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BackgroundPrehospital transfusion is a way of improving the management of hemorrhagic shock. In France, prehospital transfusion is struggling to develop, both because of logistical difficulties and particularly restrictive legislation. To comply with this, we propose to store the blood products (BPs) in ground ambulances with refrigerated boxes allowing remote continuous monitoring of storage conditions, called “NelumBox” (Tec4med Lifescience GmbH). To open them, the ambulance's team needs a code that is only given by the Transfusion Center if the request meets all required regulatory criteria.Study Design and MethodsWe conducted a prospective simulation‐based feasibility study using dummy BPs. Two ambulances were equipped. Simulations were triggered unexpectedly, including during on‐call hours. The ability to quickly access the BPs was the main judgment criterion. The quality of hemovigilance during these simulations was also examined.ResultsTwenty‐two simulations were performed. The ambulance's team was able to access the BPs in 100% of cases. The average waiting time for receiving the unlocking code was 5 min 27 s (SD = 2 min 12 s, MAX = 12 min 00 s). The transfusion traceability was compliant with regulations in 100% of cases. The transfusion center was able to remotely monitor BPs storage conditions for the entire duration of their stockage in the NelumBox.DiscussionThe present procedure is efficient, repeatable, and fast. It guarantees a strict transfusion safety without slowdown a severe trauma management, while complying with French regulations.

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Section: Resultsmentioning

confidence: 99%

“…During the waiting period, the ALS team continued to manage the patient, including venous line placements, hemostatic resuscitation, hypothermia prevention, etc 19 . Transfusion can be started while driving, following the military en‐route care strategy 20 …”

Section: Discussionmentioning

confidence: 99%

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

et al. 2023

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“…Continuous monitoring of the temperature and regular rotation of the LBPs with the blood bank or the trauma center prevent any waste. 35,36 It would be relevant to explore what the cost-benefit justification to widen PHT would be in the French system.…”

Section: Discussionmentioning

confidence: 99%

“…Civilian 31,32 or military 33,34 services use isothermal containers such as the Golden Hour Box™ (Peli Biothermal, USA) for the permanent prepositioning of LBPs on board ambulances or aircraft. Continuous monitoring of the temperature and regular rotation of the LBPs with the blood bank or the trauma center prevent any waste 35,36 . It would be relevant to explore what the cost–benefit justification to widen PHT would be in the French system.…”

Section: Discussionmentioning

confidence: 99%

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

Bichot

Pasquier²,

Martinaud

et al. 2023

Transfusion

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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.

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Trauma coagulopathy: Insights from the PROCOAG and CRYOSTAT-2 trials. Coagulation factors are not antibiotics

Gauss,

Bouzat

2024

Anaesthesia Critical Care & Pain Medicine

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Prehospital blood transfusion: Advances and interests in tactical medicine

Cited by 6 publications

References 5 publications

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

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

Trauma coagulopathy: Insights from the PROCOAG and CRYOSTAT-2 trials. Coagulation factors are not antibiotics

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