Civilian prehospital transfusion – experiences from a French region

Abstract

Background and objectives Haemorrhagic shock is a leading cause of avoidable mortality in prehospital care. For several years, our centre has followed a procedure of transfusing two units of packed red blood cells outside the hospital. Our study’s aim was twofold: describe the patient characteristics of those receiving prehospital blood transfusions and analyse risk factors for the 7‐day mortality rate. Materials and methods We performed a monocentric retrospective observational study. Demographic and physiological data were recovered from medical records. The primary outcome was mortality at seven days for all causes. All patients receiving prehospital blood transfusions between 2013 and 2018 were included. Results Out of 116 eligible patients, 56 patients received transfusions. Trauma patients (n = 18) were younger than medical patients (n = 38) (P = 0·012), had lower systolic blood pressure (P = 0·001) and had higher haemoglobin levels (P = 0·016). Mortality was higher in the trauma group than the medical group (P = 0·015). In‐hospital trauma patients received more fresh‐frozen plasma and platelet concentrate than medical patients (P < 0·05). Predictive factors of 7‐day mortality included transfusion for trauma‐related reasons, low Glasgow Coma Scale, low peripheral oxygen saturation, prehospital intensive resuscitation, existing coagulation disorders, acidosis and hyperlactataemia (P < 0·05). Conclusion Current guidelines recommend early transfusion in patients with haemorrhagic shock. Prehospital blood transfusions are safe. Coagulation disorders and acidosis remain a cause of premature death in patients with prehospital transfusions.

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.…”

“…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

“…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 [ 10 , 12 , 15 ]. The traumatic group consisted of younger, mostly males suffering blunt traumas [ 2 , 12 , 17 ].…”

Early packed red blood cell transfusion in major trauma patients: Evaluation and comparison of different prediction scores for massive transfusion

“…The objective of these scores is to identify major trauma patients requiring transfusion at an early stage in order to anticipate the amount of labile blood products needing to be ordered by the receiving trauma centre [8]. Although the capability for pre‐hospital blood transfusion is being implemented in some areas, it is not yet widely accepted as a standard practice [9]. Effective pre‐hospital management and triage of these major trauma patients to dedicated trauma centres reduce their mortality by 25% [10].…”

“…Although the capability for pre-hospital blood transfusion is being implemented in some areas, it is not yet widely accepted as a standard practice [9]. Effective pre-hospital management and triage of these major trauma patients to dedicated trauma centres reduce their mortality by 25% [10].…”