Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study

Abstract

Background: Early resuscitation with blood components or products is emerging as best practice in selected patients with trauma and medical patients; as a result, out-of-hospital transfusion (OHT) programs are being developed based on limited and often conflicting evidence. This study aimed to provide guidance to Canadian critical care transport organizations on the development of OHT protocols. Methods: The study period was July 2021 to June 2022. We used a modified RAND Delphi process to achieve consensus on statements created by the study team guiding various aspects of OHT in the context of critical care transport. Purposive sampling ensured representative distribution of participants in regard to geography and relevant clinical specialties. We conducted 2 written survey Delphi rounds, followed by a virtual panel discussion (round 3). Consensus was defined as a median score of at least 6 on a Likert scale ranging from 1 (“Definitely should not include”) to 7 (“Definitely should include”). Statements that did not achieve consensus in the first 2 rounds were discussed and voted on during the panel discussion. Results: Seventeen subject experts participated in the study, all of whom completed the 3 Delphi rounds. After the study process was completed, a total of 39 statements were agreed on, covering the following domains: general oversight and clinical governance, storage and transport of blood components and products, initiation of OHT, types of blood components and products, delivery and monitoring of OHT, indications for and use of hemostatic adjuncts, and resuscitation targets of OHT. Interpretation: This expert consensus document provides guidance on OHT best practices. The consensus statements should support efficient and safe OHT in national and international critical care transport programs.

Infusionswärmer zur Hämotherapie in der Notfallmedizin: Ist die schnelle Gabe gewärmter Blutprodukte prähospital möglich?

“…Einschränkend muss angemerkt werden, dass im Rahmen des Projekts HeliBlut aktuell keine Aussagen bezüglich des Patienten-Outcomes nach Transfusion von 2 Erythrozytenkonzentraten in der Präklinik getroffen werden kann, somit kann die Relevanz der Flusslimitation nicht endgültig beurteilt werden. Hier sollen weitere Daten über die Indikationsstellung, Durchführung, Probleme, Effektivität und Kosten der präklinischen Applikation von Blutprodukten erhoben werden [13][14][15].…”

Assessing the one‐month mortality impact of civilian‐setting prehospital transfusion: A systematic review and meta‐analysis

“…In our broad definition of transfusion, we chose to follow the path set by a recent multidisciplinary consensus-building CivPHT conference. 2…”

“…In the military trauma setting, prehospital transfusion (PHT) is a firmly evidenced means to reduce preventable death. 1 Increasing awareness of military-setting mortality benefits of PHT-defined in this review as in others 2 to include prehospital administration of whole blood (WB), red blood cells (RBCs), plasma (any form), or other blood product(s)-has spurred PHT adoption in some civilian U.S. jurisdictions 3 and consideration in others. Civilian PHT (CivPHT) has support from national organizations such as the American College of Surgeons and American College of Emergency Physicians (in a joint position statement 4 ) as well as favorable mention on U.S. government websites (e.g., https://www.…”

“…alloimmunization), and resource requirements, questions remain and debate continues. 2,5,6 Issues surrounding CivPHT are being actively addressed by ongoing randomized trials such as the Type O Whole Blood and Assessment of Age During Prehospital Resuscitation (TOWAR, clini caltr ials. gov 04684719).…”