Prehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients

Sumida, Michael P.; Quinn, Karen; Lewis, Patricia L.; Jones, Yonna; Barker, Donald E.; Ciraulo, David L.; Cowell, Vernon; Luk, Stephen S.; Murphy, Diane; Jacobs, Lenworth M.

doi:10.1016/s1067-991x(00)90007-5

Cited by 41 publications

(34 citation statements)

References 16 publications

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“…Sumida compared 17 patients receiving PTC RBC with 31 patients receiving more than 2L of crystalloid only. (36) The authors found no difference in unadjusted outcomes despite longer prehospital time and higher base deficit in the PTC RBC group.…”

Section: Discussionmentioning

confidence: 88%

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

Brown

Sperry

Fombona

et al. 2015

Journal of the American College of Surgeons

161

126

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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.

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Section: Discussionmentioning

confidence: 88%

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

Brown

Sperry

Fombona

et al. 2015

Journal of the American College of Surgeons

161

126

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“…Sumida and colleagues 32 compared outcomes between patients receiving PTC RBC transfusion versus those receiving only crystalloids in 31 HEMS trauma patients. Seventeen received PTC RBC transfusion with a combination of scene and transfer patients.…”

Section: Discussionmentioning

confidence: 99%

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Brown¹,

Cohen

Minei

et al. 2015

Annals of Surgery

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Objective To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01–0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15–0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02–0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01–0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03–0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01–0.95; P = 0.05). Conclusions PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

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“…With longer flights, patients not receiving transfusion therapy for hemorrhage could be predicted to arrive more acidemic due to hypoxia and anerobic metabolism; however, in patients receiving blood products, previous studies have suggested no mortality difference between patients with extended flight times and shorter transports. 5 Therefore, programs with longer transport times may be able to provide more complete and targeted care in the prehospital setting, as opposed to programs that tend to have short transports and can reach a tertiary care hospital quickly. Some programs have transport times so short that would not even permit blood to be hung on flight before reaching a hospital where blood could then be administered.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Several authors have recommended the infusion of two liters of crystalloid solution to maintain blood pressure and cardiac output followed by packed red blood cells, which improves oxygen delivery and increases hematocrit. [4][5][6] Importance Prehospital blood transfusions may be justified in certain trauma patients, especially when prolonged prehospital transport is required. 7 Some recent literature has supported improved outcomes for trauma patients who receive prehospital blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

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

Karl

Pham

Yanosky³

et al. 2016

Prehospital Emergency Care

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Prehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients

Cited by 41 publications

References 16 publications

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

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

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

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

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