Characteristics of Nontrauma Patients Receiving Prehospital Blood Transfusion with the Same Triggers as Trauma Patients: A Retrospective Observational Cohort Study

Abstract

While prehospital blood transfusion (PHBT) for trauma patients has been established in many services, the literature on PHBT use for nontrauma patients is limited. We aimed to describe and compare nontrauma and trauma patients receiving PHBT who had similar hemodynamic triggers. Methods. We analyzed 3.5 years of registry data from a single prehospital critical care unit. The PHBT protocol included two packed red blood cell units and was later completed with two freeze-dried plasma units. The transfusion triggers were a strong clinical suspicion of massive hemorrhage and systolic blood pressure below 90 mmHg or absent radial pulse. Results. Thirty-six nontrauma patients and 96 trauma patients received PHBT. The nontrauma group had elderly patients (median 65 [interquartile range, IQR, 56-73] vs A c c e p t e d M a n u s c r i p t 2 37 [IQR 25-57] years, p < 0.0001) and included patients with gastrointestinal bleeding (n = 15; 42%), vascular catastrophes (n = 9; 25%), postoperative bleeding (n = 6; 17%), obstetrical bleeding (n = 4; 11%) and other (n = 2; 6%). Cardiac arrest occurred in nine (25%) nontrauma and in 15 (16%) trauma patients. Of these, 5 (56%) and 10 (67%) survived to hospital admission and 3 (33%) and 2 (13%) to hospital discharge. On admission, the nontrauma patients had lower hemoglobin (median 95 [84-119] vs 124 [108-133], p < 0.0001), higher pH (median 7.40 [7.27-7.44] vs 7.30 [7.19-7.36], p = 0.0015) and lower plasma thromboplastin time (median 55 [45-81] vs 72 [58-86], p = 0.0261) than the trauma patients. Conclusions. We identified four nontrauma patient groups in need of PHBT, and the patients appeared to be seriously ill. Efficacy of prehospital transfusion in nontrauma patients should be evaluated futher in becoming studies.

Initial experiences of prehospital blood product transfusions between 2016-2020 in Päijät-Häme hospital district, Finland

“…Nearly half of the patients receiving PHBT were non-traumatic, with the most common reason being gastrointestinal hemorrhage. Previous studies have reported the non-traumatic group being anywhere from 22-68% of the patients receiving PHBT and gastrointestinal hemorrhage being the most common reason [10,12,14,15,16]. The patient characteristics observed in our study closely echo previous research.…”

“…In our study, the median delay would have been around 115 minutes from start of the emergency call to arrival to the hospital. Similar delays have been reported also by Lyon et al [2] 114 min delay, Vuorinen et all [14] 103 min delay and Ångerman et al [12] 97 min delay for non-traumatic patients and 83 min for traumatic. In this study, the PHBT was started median 54 minutes (IQR 38) from the emergency call and for trauma patients the median time was 51 minutes and for non-traumatic 54 minutes.…”

“…In this study, the PHBT was started median 54 minutes (IQR 38) from the emergency call and for trauma patients the median time was 51 minutes and for non-traumatic 54 minutes. These times compare well with Finnish HEMS units, for Tampere HEMS (FH30) it takes on median 71 minutes (IQR 34) form the start of the emergency call to start of the prehospital blood transfusion [14] and for Vantaa HEMS unit (FH10) it takes median 49 minutes (IQR 28) for trauma patients and 64 minutes (IQR 30) for non-traumatic patients [12].…”

“…The patient characteristics observed in our study closely echo previous research. Overall, the non-traumatic group consisted of older patients and in deeper anemia compared to the traumatic group [12,10,15]. The traumatic group consisted of younger, mostly males suffering blunt traumas [2,12,17].…”

Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland

“…In addition, non-traumatic hemorrhaging patients can also form a significant group that could benefit from prehospital transfusions [ 10 – 12 ]. Causes for non-traumatic hemorrhaging can include different reasons for postoperative complications, gastrointestinal hemorrhaging, and obstetric and gynecological emergencies.…”