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Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid

Griggs, J.E., Jeyanathan, J., Joy, M., Russell, M.Q., Durge, N., Bootland, D., Dunn, S., Sausmarez, E.D., Wareham, G., Weaver, A. and Lyon, R.M. (2018) Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

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Abstract

Background

Major haemorrhage is a leading cause of mortality following major trauma. Increasingly, Helicopter Emergency Medical Services (HEMS) in the United Kingdom provide pre-hospital transfusion with blood products, although the evidence to support this is equivocal. This study compares mortality for patients with suspected traumatic haemorrhage transfused with pre-hospital packed red blood cells (PRBC) compared to crystalloid.

Methods

A single centre retrospective observational cohort study between 1 January 2010 and 1 February 2015. Patients triggering a pre-hospital Code Red activation were eligible. The primary outcome measure was all-cause mortality at 6 hours and 28 days, including a sub-analysis of patients receiving a major and massive transfusion. Multivariable regression models predicted mortality. Multiple Imputation (MI) was employed, and logistic regression models were constructed for all imputed datasets.

Results

The crystalloid (n= 103) and PRBC (n= 92) group were comparable for demographics, Injury Severity Score (p= 0.67) and mechanism of injury (p= 0.74). Observed 6 hour mortality was smaller in the PRBC group (n= 10, 10%) compared to crystalloid group (n= 19, 18%). Adjusted OR was not statistically significant (OR 0.48, CI 0.19-1.19, p= 0.11). Observed mortality at 28 days was smaller in the PRBC group (n= 21, 27%) compared to crystalloid group (n= 31, 40%), p= 0.09. Adjusted OR was not statistically significant (OR 0.66, CI 0.32-1.35, p= 0.26). A statistically significant greater proportion of the crystalloid group required a major transfusion (n= 62, 63%) compared to the PRBC group (n= 41, 46%), p= 0.02. For patients requiring a massive transfusion observed mortality was smaller in the PRBC group at 28 days (p= 0.07).

Conclusion

In a single centre UK HEMS study, in patients with suspected traumatic haemorrhage who received a PRBC transfusion there was an observed, but non-significant, reduction in mortality at 6 hours and 28 days, also reflected in a massive transfusion subgroup. Patients receiving pre-hospital PRBC were significantly less likely to require an in-hospital major transfusion. Further adequately powered multi-centre prospective research is required to establish the optimum strategy for pre-hospital volume replacement in patients with traumatic haemorrhage.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
NameEmailORCID
Griggs, J.E.
Jeyanathan, J.
Joy, M.m.joy@surrey.ac.uk
Russell, M.Q.
Durge, N.
Bootland, D.
Dunn, S.
Sausmarez, E.D.
Wareham, G.
Weaver, A.
Lyon, R.M.r.lyon@surrey.ac.uk
Date : 2018
Copyright Disclaimer : © The authors 2018
Uncontrolled Keywords : Transfusion; Packed Red Blood Cells; Crystalloid; Mortality; Traumatic Haemorrhage; Helicopter Emergency Medical Services
Related URLs :
Depositing User : Clive Harris
Date Deposited : 13 Nov 2018 09:26
Last Modified : 13 Nov 2018 09:26
URI: http://epubs.surrey.ac.uk/id/eprint/849857

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