A report of two years of pre-hospital blood transfusions by Thames Valley Air Ambulance

Abstract

Introduction: Thames Valley Air Ambulance have carried two units of red blood cells on board both the aircraft and rapid response car since 2014. Methods: A retrospective database narrative review of patients receiving blood was carried out. Results: Data were analysed for 63 patients, the age range was 13 years to 89 years and 74.6% were male. Blunt trauma was the mechanism of injury in 84%. Overall, 16% of patients died at scene, 32% died either in the Emergency Department or as a hospital inpatient and 52% survived to discharge. There were no survivors from traumatic cardiac arrest who received blood products. Injury Severity Scores (ISS) ranged from 4 to 75, and 95% of the patients for whom data were available had an Injury Severity Scores greater than 15. Discussion: Patients who received pre-hospital blood transfusions were overwhelmingly those with high Injury Severity Scores and the majority who survived to hospital received additional blood products on arrival. This suggests that our pre-hospital blood transfusions were correctly targeted to severely injured patients who had a need for blood transfusion in hospital.

Pre‐hospital transfusion of red blood cells. Part 2: A systematic review of treatment effects on outcomes

“…Blunt injury was most prevalent in the included studies, ranging from 55% to 100% of trauma patients . The mean or median injury severity score (ISS) varied from 18 to 43 (Table ) . The most frequent mechanisms of injury were motor vehicle collisions (42%‐88%) and falls from a height (3.4%‐13%) …”

“…The mean or median injury severity score (ISS) varied from 18 to 43 (Table ) . The most frequent mechanisms of injury were motor vehicle collisions (42%‐88%) and falls from a height (3.4%‐13%) …”

“…Data on non‐trauma patients were reported in 16 civilian studies and made up 3% to 100% of these study cohorts . Suspected gastro‐intestinal bleeding or ruptured aortic aneurysm were the most often reported non‐traumatic diagnoses in transfused patients.…”

“…In the first 24 hours after admission to hospital, civilian patients received a median of 0 to 14 U of RBC, and paediatric patients received a mean of 3.6 U …”

Pre‐hospital transfusion of red blood cells. Part 1: A scoping review of current practice and transfusion triggers

“…In patients treated by a civilian EMS, 5 studies reported a mean/median of 1 unit transfused, 17 studies report a mean/median of 1.1 to 2 units (or between 280 and 560 mL) and 8 studies reported a mean/median of 2.3 to 3 units transfused (or between 560 and 840 mL) . Paediatric patients received a mean of 9.8 mL/kg or 255 mL (8 mL/kg) …”