Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service

Lyon, Richard, de Sausmarez, E, McWhirter, Emily, Wareham, G, Nelson, M, Matthies, A, Hudson, A, Curtis, L and Russell, MQ (2017) Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25 (12).

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Abstract

Background: Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery. Methods: The decision to administer a pre-hospital PRBC transfusion was based on clinical judgment. All patients transfused pre-hospital PRBC between February 2013 and December 2014 were included. Pre-hospital and in-hospital records were retrospectively reviewed. Results: One hundred forty-seven patients were included. 142 patients had traumatic injuries and 5 patients had haemorrhagic shock from a medical origin. Median Injury Severity Score was 30. 90% of patients receiving PRBC had an ISS of >15. Patients received a mean of 2.4(±1.1) units of PRBC in the pre-hospital phase. Median time from initial emergency call to hospital arrival was 114 min (IQR 103–140). There was significant improvement in systolic (p < 0.001), diastolic (p < 0.001) and mean arterial pressures (p < 0.001) with PRBC transfusion but there was no difference in HR (p = 0.961). Patients received PRBC significantly faster in the field than waiting until hospital arrival. At the receiving hospital 57% required an urgent surgical or interventional radiology procedure. At hospital arrival, patients had a mean lactate of 5.4(±4.4) mmol/L, pH of 6.9(±1.3) and base deficit of −8.1(±6.7). Mean initial serum adjusted calcium was 2.26(±0.29) mmol/L. 89% received further blood products in hospital. No transfusion complications or significant incidents occurred and 100% traceability was achieved. Discussion: Pre-hospital transfusion of packed red cells has the potential to improvde outcome for trauma patients with major haemorrhage. The pre-hospital time for trauma patients can be several hours, suggesting transfusion needs to start in the pre-hospital phase. Hospital transfusion research suggests a 1:1 ratio of packed red blood cells to plasma improves outcome and further research into pre-hospital adoption of this strategy is needed. Conclusion: Pre-hospital PRBC transfusion significantly reduces the time to transfusion for major trauma patients with suspected major haemorrhage. The majority of patients receiving pre-hospital PRBC were severely injured and required further transfusion in hospital. Further research is warranted to determine which patients are most likely to have outcome benefit from pre-hospital blood products and what triggers should be used for pre-hospital transfusion.

Item Type:	Article
Subjects :	Health Sciences
Divisions :	Faculty of Health and Medical Sciences > School of Health Sciences
Authors :	Name Email ORCID Lyon, Richard r.lyon@surrey.ac.uk de Sausmarez, E McWhirter, Emily e.mcwhirter@surrey.ac.uk Wareham, G Nelson, M Matthies, A Hudson, A Curtis, L Russell, MQ
Date :	14 February 2017
DOI :	10.1186/s13049-017-0356-2
Copyright Disclaimer :	© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords :	: Haemorrhage, Pre-hospital care, Trauma
Depositing User :	Symplectic Elements
Date Deposited :	23 Feb 2017 12:23
Last Modified :	16 Jan 2019 17:12
URI:	http://epubs.surrey.ac.uk/id/eprint/813625

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