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

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.

Massive transfusion in trauma

“…Group A plasma is now also available for untyped patients demonstrating noninferiority to AB-plasma, the impact of plasma ABO-incompatibility on clinical outcomes is insignificant [25 ▪ ]. Being a superior isometric buffer compared to crystalloids, plasma is an ideal volume expander in the intravascular space, has a homeostatic effect on endothelial function and innate immune system activation [25 ▪ ,32]. FFP-based resuscitation improves intestinal perfusion immediately following resuscitation, which correlates with improved tissue oxygenation and decreased tissue CO 2 -levels [33].…”

Guidelines in trauma-related bleeding and coagulopathy: an update

“…The early administration of both agents in the aforementioned sequence promotes blood clot formation and stability [22] and was associated with survival in retrospective studies [23]. The prehospital provision of blood products (erythrocyte and plasma concentrates including lyophylized plasma) remains under debate in the light of recent studies [24][25][26][27][28][29][30][31][32]…”

“…The early administration of both agents in the aforementioned sequence promotes blood clot formation and stability [22] and was associated with survival in retrospective studies [23]. The prehospital provision of blood products (erythrocyte and plasma concentrates including lyophylized plasma) remains under debate in the light of recent studies [24–32] and can be considered for patients with uncontrollable bleeding, provided that appropriate logistics are in place and the administration does not delay transport (AWMF: 0 [11 ▪▪ ]). At present, the EU-Trauma guideline refrains from a clear recommendation due to still inconsistent data [13 ▪▪ ].…”

Journal update monthly top five

“…While red blood cell (RBC) transfusion can assist in managing traumatic haemorrhage, RBC transfusion alone does not restore coagulation and clotting factors lost during bleeding. In this prospective randomised multicentre study from England, investigators studied the outcomes for three transfusion strategies for patients with traumatic haemorrhage in the prehospital environment: (1) RBC alone, (2) leucocyte-depleted red cell and plasma (RCP) and (3) RBC and plasma 4…”