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Multicenter Study
. 2023 Jan 17;27(1):25.
doi: 10.1186/s13054-022-04279-4.

Association of red blood cells and plasma transfusion versus red blood cell transfusion only with survival for treatment of major traumatic hemorrhage in prehospital setting in England: a multicenter study

Harriet Tucker  1 , Karim Brohi  1   2 , Joachim Tan  3 , Christopher Aylwin  4 , Roger Bloomer  5 , Rebecca Cardigan  6 , Ross Davenport  1   2 , Edward D Davies  7 , Phillip Godfrey  8 , Rachel Hawes  9   10 , Richard Lyon  11 , Josephine McCullagh  2 , Simon Stanworth  6   12 , Julian Thompson  13   14 , James Uprichard  15 , Simon Walsh  4   16 , Anne Weaver  2 , Laura Green  17   18   19
Affiliations
Multicenter Study

Association of red blood cells and plasma transfusion versus red blood cell transfusion only with survival for treatment of major traumatic hemorrhage in prehospital setting in England: a multicenter study

Harriet Tucker et al. Crit Care. .

Abstract

Background: In-hospital acute resuscitation in trauma has evolved toward early and balanced transfusion resuscitation with red blood cells (RBC) and plasma being transfused in equal ratios. Being able to deliver this ratio in prehospital environments is a challenge. A combined component, like leukocyte-depleted red cell and plasma (RCP), could facilitate early prehospital resuscitation with RBC and plasma, while at the same time improving logistics for the team. However, there is limited evidence on the clinical benefits of RCP.

Objective: To compare prehospital transfusion of combined RCP versus RBC alone or RBC and plasma separately (RBC + P) on mortality in trauma bleeding patients.

Methods: Data were collected prospectively on patients who received prehospital transfusion (RBC + thawed plasma/Lyoplas or RCP) for traumatic hemorrhage from six prehospital services in England (2018-2020). Retrospective data on patients who transfused RBC from 2015 to 2018 were included for comparison. The association between transfusion arms and 24-h and 30-day mortality, adjusting for age, injury mechanism, age, prehospital heart rate and blood pressure, was evaluated using generalized estimating equations.

Results: Out of 970 recruited patients, 909 fulfilled the study criteria (RBC + P = 391, RCP = 295, RBC = 223). RBC + P patients were older (mean age 42 vs 35 years for RCP and RBC), and 80% had a blunt injury (RCP = 52%, RBC = 56%). RCP and RBC + P were associated with lower odds of death at 24-h, compared to RBC alone (adjusted odds ratio [aOR] 0.69 [95%CI: 0.52; 0.92] and 0.60 [95%CI: 0.32; 1.13], respectively). The lower odds of death for RBC + P and RCP vs RBC were driven by penetrating injury (aOR 0.22 [95%CI: 0.10; 0.53] and 0.39 [95%CI: 0.20; 0.76], respectively). There was no association between RCP or RBC + P with 30-day survival vs RBC.

Conclusion: Prehospital plasma transfusion for penetrating injury was associated with lower odds of death at 24-h compared to RBC alone. Large trials are needed to confirm these findings.

Keywords: Combined red cell and plasma; Mortality; Prehospital transfusion; Trauma.

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Conflict of interest statement

All authors declare the following: LG, RC, SS are employees of NHSBT and report obtaining research funds for multiple clinical studies, but they report no direct relevant financial disclosures. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of study recruitment
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