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. 2017 Feb 14;25(1):12.
doi: 10.1186/s13049-017-0356-2.

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

Richard M Lyon  1   2 , Eleanor de Sausmarez  3 , Emily McWhirter  3   4 , Gary Wareham  3 , Magnus Nelson  3 , Ashley Matthies  5 , Anthony Hudson  5 , Leigh Curtis  3 , Malcolm Q Russell  3 ; Kent, Surrey & Sussex Air Ambulance Trust
Affiliations

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

Richard M Lyon et al. Scand J Trauma Resusc Emerg Med. .

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.

Keywords: Haemorrhage; Pre-hospital care; Trauma.

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Figures

Fig. 1
Fig. 1
Inclusion of patients
Fig. 2
Fig. 2
Frequency distribution of number of units of PRBC transfused pre-hospital. One patient received 5 units of PRBC as two HEMS were at the same incident, meaning more PRBC were available
Fig. 3
Fig. 3
Mean (SD) physiological parameters on arrival of HEMS team, initiation of blood and arrival in the ED. * Denotes significant difference (p < 0.05) between value on initiation of blood when compared to arrival in the ED
See this image and copyright information in PMC

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