Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial

Crombie, Nicholas; Doughty, Heidi; Bishop, Jonathan; Desai, Amisha; Dixon, Emily; Hancox, James M; Herbert, Mike; Leech, Caroline; Lewis, Simon J.G.; Nash, Mark; Naumann, David N; Slinn, Gemma; Smith, Hazel; Smith, Iain M; Wale, Rebekah; Wilson, Alastair J.; Ives, Natalie; Perkins, Gavin D

doi:10.1016/s2352-3026(22)00040-0

Cited by 134 publications

(126 citation statements)

References 28 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…The current research is not clear whether prehospital blood product transfusions benefit the patient when compared to saline. [ 3 , 18 ] To recognize the patient groups that would benefit earlier blood product or whole blood transfusions needs more research.…”

Section: Discussionmentioning

confidence: 99%

Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland

Yliharju

Jama

Nordquist

2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background Treating hemorrhaging patients with prehospital blood product transfusions (PHBT) narrows transfusion delays and potentially benefits the patient. We describe our initial experiences of PHBT in a ground-based emergency medical service (EMS), where the transfusion protocol covers both traumatic and nontraumatic hemorrhaging patients. Methods A descriptive retrospective analysis was performed on the records of all the patients receiving red blood cells, freeze-dried plasma, or both during prehospital care from September 2016 to December 2020. The delays of PHBT and the effects on patients’ vital signs were analyzed and reported as the median and interquartile range (IQR) and analyzed using a Wilcoxon Signed rank test. Results 65 patients received prehospital blood product transfusions (PHBT), 29 (45%) were non-traumatic, and 36 (55%) traumatic. The main two reasons for PHBT were blunt trauma (n = 30, 46%) and gastrointestinal hemorrhage (n = 20, 31%). The median time from the emergency call to the start of PHBT was 54 min (IQR 38), and the transfusion began on a median of 61 min (IQR 42) before arrival at the hospital. The median systolic blood pressure improved from a median 76.5 mmHg (IQR 36.5) before transfusion to a median of 116.60 mmHg (IQR 26.5) (p < 0.001) on arrival to the hospital. No transfusion-related severe adverse events were noted. Conclusions Starting PHBT in ground-based EMS is a feasible and viable option. The PHBT began significantly earlier than it would have started on arrival to the hospital, and it seems to be safe and improve patients’ physiology. Study approval D/2603/07.01.04.05/2019.

show abstract

Section: Discussionmentioning

confidence: 99%

Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland

Yliharju

Jama

Nordquist

2022

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…Whole blood has also been used and may have logistical advantages over component therapy in the pre-hospital setting [ 53 ]. Although the recently published RePHILL trial could not demonstrate a survival benefit for patients with haemorragic shock who received pre-hospital blood component therapy compared to those who received normal saline, the results should not be extrapolated to patients exsanguinating from NCH due to penetrating injuries, as these patients were significantly underrepresented in this trial [ 54 ].…”

Section: Patients Presenting With Profound Shockmentioning

confidence: 99%

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

et al. 2022

View full text Add to dashboard Cite

Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood products, resuscitative thoracotomy (RT) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have become available in a small number of pre-hospital critical care teams. Although these advanced techniques are included in the current traumatic cardiac arrest algorithm of the European Resuscitation Council (ERC), published in 2021, clear guidance on the practical application of these techniques in the pre-hospital setting is scarce. This paper provides a scoping review on how these advanced techniques can be incorporated into practice for the resuscitation of patients exsanguinating from NCH after penetrating injuries, based on available literature and the collective experience of several helicopter emergency medical services (HEMS) across Europe who have introduced these advanced resuscitation interventions into routine practice. Graphical Abstract

show abstract

“…The optimal fluid for prehospital resuscitation in trauma is uncertain. Military studies suggest a significant survival advantage for trauma patients receiving prehospital transfusion of packed red blood cells (PRBCs) and pre-thawed plasma compared with crystalloid 1…”

Section: Resuscitation With Blood Products In Patients With Trauma-re...mentioning

confidence: 99%

Journal update monthly top five

et al. 2022

View full text Add to dashboard Cite

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial

Cited by 134 publications

References 28 publications

Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland

Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

Journal update monthly top five

Contact Info

Product

Resources

About