Prehospital Use of Whole Blood for Ill and Injured Patients During Critical Care Transport

Nawrocki, Philip S.; Mulcahy, Brendan; Shukis, Michael; Poremba, Matthew

doi:10.1016/j.amj.2022.05.003

Cited by 2 publications

(3 citation statements)

References 21 publications

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“…Second, this manuscript was not designed to prove that prehospital WBTs are beneficial for trauma patients, but rather serve as a road map for other agencies to add such a program to their systems. However, given the known harms from excessive crystalloid use in trauma patients [20][21][22]29 and the recent suggested benefits of WBTs, [6][7][8][9]14,16 the authors of this manuscript feel that Palm Beach County's WBT program allows for better care of critically ill trauma patients. Finally, Palm Beach County Fire Rescue's WBT program is currently only used for trauma patients, but they plan to expand that to medical patients in hemorrhagic shock.…”

Section: Limitationsmentioning

confidence: 99%

“…8,9 In the prehospital setting, with only one blood product to store and administer, WBT is simpler than component therapy, which may not be feasible for some Emergency Medical Service (EMS) systems. Indeed, some other countries, including Norway 10,11 and Israel, 12 and some other locations within the United States, including San Antonio, Texas 13 and Pittsburgh, Pennsylvania, 14,15 have been using WBTs for years. Data from these systems have suggested that prehospital WBT is safe and may even improve survival.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, some other countries, including Norway 10,11 and Israel, 12 and some other locations within the United States, including San Antonio, Texas 13 and Pittsburgh, Pennsylvania, 14,15 have been using WBTs for years. Data from these systems have suggested that prehospital WBT is safe 12,14 and may even improve survival. 16 Despite these data, only a few EMS systems have implemented prehospital WBT programs.…”

Section: Introductionmentioning

confidence: 99%

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The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results

Coyle

Zitek

Pepe

et al. 2023

Prehosp. Disaster med.

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Introduction: In far-forward combat situations, the military challenged dogma by using whole blood transfusions (WBTs) rather than component-based therapy. More recently, some trauma centers have initiated WBT programs with reported success. There are a few Emergency Medical Service (EMS) systems that are using WBTs, but the vast majority are not. Given the increasing data supporting the use of WBTs in the prehospital setting, more EMS systems are likely to consider or begin WBT programs in the future. Objective: A prehospital WBT program was recently implemented in Palm Beach County, Florida (USA). This report will discuss how the program was implemented, the obstacles faced, and the initial results. Methods: This report describes the process by which a prehospital WBT program was implemented by Palm Beach County Fire Rescue and the outcomes of the initial case series of patients who received WBTs in this system. Efforts to initiate the prehospital WBT program for this system began in 2018. The program had several obstacles to overcome, with one of the major obstacles being the legal team’s perception of potential liability that might occur with a new prehospital blood transfusion program. This obstacle was overcome through education of local elected officials regarding the latest scientific evidence in favor of prehospital WBTs with potential life-saving benefits to the community. After moving past this hurdle, the program went live on July 6, 2022. The initial indications for transfusion of cold-stored, low titer, leukoreduced O+ whole blood in the prehospital setting included traumatic injuries with systolic blood pressure (SBP) < 70mmHg or SBP < 90mmHg plus heart rate (HR) > 110 beats per minute. Findings: From the date of onset through December 31, 2022, Palm Beach County Fire Rescue transported a total of 881 trauma activation patients, with 20 (2.3%) receiving WBT. Overall, nine (45%) of the patients who had received WBTs so far remain alive. No adverse events related to transfusion were identified following WBT administration. A total of 18 units of whole blood reached expiration of the unit’s shelf life prior to transfusion. Conclusion: Despite a number of logistical and legal obstacles, Palm Beach County Fire Rescue successfully implemented a prehospital WBT program. Other EMS systems that are considering a prehospital WBT program should review the included protocol and the barriers to implementation that were faced.

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Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results

Coyle

Zitek

Pepe

et al. 2023

Prehosp. Disaster med.

View full text Add to dashboard Cite

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Edema and lymphatic clearance: molecular mechanisms and ongoing challenges

Breslin

2023

Clinical Science

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Resolution of edema remains a significant clinical challenge. Conditions such as traumatic shock, sepsis, or diabetes often involve microvascular hyperpermeability, which leads to tissue and organ dysfunction. Lymphatic insufficiency due to genetic causes, surgical removal of lymph nodes, or infections, leads to varying degrees of tissue swelling that impair mobility and immune defenses. Treatment options are limited to management of edema as there are no specific therapeutics that have demonstrated significant success for ameliorating microvascular leakage or impaired lymphatic function. This review examines current knowledge about the physiological, cellular, and molecular mechanisms that control microvascular permeability and lymphatic clearance, the respective processes for interstitial fluid formation and removal. Clinical conditions featuring edema, along with potential future directions are discussed.

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Prehospital Use of Whole Blood for Ill and Injured Patients During Critical Care Transport

Cited by 2 publications

References 21 publications

The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results

The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results

Edema and lymphatic clearance: molecular mechanisms and ongoing challenges

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