Effect of Prehospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients

Rehn, Marius; Weaver, Anne; Brohi, Karim; Eshelby, Sarah; Green, Laura; Røislien, Jo; Lockey, David

doi:10.1097/shk.0000000000001166

Cited by 86 publications

(104 citation statements)

References 34 publications

(17 reference statements)

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“…In a retrospective study of that system, Rehn and colleagues evaluated outcomes of patients treated with either hypotensive crystalloid resuscitation or PRBCs. Of 539 patients with major haemorrhage, there was no difference in overall mortality between the two groups but there was a significant reduction in prehospital mortality in the PRBC group (27·6% vs. 42·2%) .…”

Section: Modern Prehospital Resuscitationmentioning

confidence: 84%

The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

Pokorný

Braverman

Edmundson

et al. 2019

ISBT Science Series

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Background Prehospital management of the traumatically injured patient has evolved significantly since the organization of emergency medical services across the United States in the 1970s. Initially focusing on the utilization of crystalloid solutions to restore shed blood volume, robust military and civilian trauma experiences led to a modern day shift towards balanced blood component and ultimately whole blood use for immediate volume replacement. In addition, prehospital transfusion or remote damage control resuscitation (RDRC) has been widely adopted. This has led to point of injury resuscitation using blood products both in the United States and abroad. Objectives This article will review the evolution of civilian and military prehospital resuscitation as well as the current practice of prehospital whole blood transfusion in the civilian trauma population in the United States. Additionally, we will provide an overview of our regional trauma system's use of whole blood with focus on the programme infrastructure, donor programme, product rotation schedule and logistical challenges. Finally, we provide three case report examples of the effective use of whole blood in our civilian emergency medical services (EMS) programs.

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Section: Modern Prehospital Resuscitationmentioning

confidence: 84%

The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

Pokorný

Braverman

Edmundson

et al. 2019

ISBT Science Series

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show abstract

“…In total, 47 civilian studies reported on trauma patients. 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 ) .…”

Section: Resultsmentioning

confidence: 99%

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

Turenhout

Bossers

Loer

et al. 2020

Transfusion Medicine

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The primary aim of this systematic review is to describe the effects of prehospital transfusion of red blood cells (PHTRBC) on patient outcomes. Damage control resuscitation attempts to prevent death through haemorrhage in trauma patients. In this context, transfusion of red blood cells is increasingly used by emergency medical services (EMS). However, evidence on the effects on outcomes is scarce. PubMed and Web of Science were searched through January 2019; 55 articles were included. No randomised controlled studies were identified. While several observational studies suggest an increased survival after PHTRBC, consistent evidence for beneficial effects of PHTRBC on survival was not found. PHTRBC appears to improve haemodynamic parameters, but there is no evidence that shock on arrival to hospital is averted, nor of an association with trauma induced coagulopathy or with length of stay in hospitals or intensive care units. In conclusion, PHTRBC is increasingly used by EMS, but there is no strong evidence for effects of PHTRBC on mortality. Further research with study designs that allow causal inferences is required for more conclusive evidence. The combination of PHTRBC with plasma, as well as the use of individualised transfusion criteria, may potentially show more benefits and should be thoroughly investigated in the future. The review was registered at Prospero (CRD42018084658). K E Y W O R D Sdamage control resuscitation, emergency medical service, major haemorrhage, mortality, outcome, prehospital transfusion, red blood cells

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“…30,31 At the end of the simulations (minute 240), however, there were very few differences between the crystalloid and prehospital transfusion (PH) simulations for each of the three resuscitation strategies (WB only, CCT only, or WB + CCT). As most trauma patients who die do so in the first 3 hours following admission, 32,33 interventions that prevent derangement of coagulation early in the resuscitation might be beneficial in improving mortality. However, very little of the crystalloid fluid remained in the ECF compartment by the end of the simulation due to ongoing bleeding and fluid redistribution.…”

Section: Discussionmentioning

confidence: 99%

In silico model of the dilutional effects of conventional component therapy versus whole blood in the management of massively bleeding adult trauma patients

et al. 2018

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ABBREVIATIONS: AS = additive solution; CCT = conventional component therapy; CPD = citrate-phosphate-dextrose; ECF = extracellular fluid; ED = emergency department; INR = international normalized ratio; ISF = interstitial fluid; LTOWB = low titer group O whole blood; OR = operating room; PC = plasma compartment; PH = prehospital blood product transfusion in place of crystalloid; PLT = platelet; PT = prothrombin time; PV = plasma volume; SBP = systolic blood pressure; WB = whole blood From the

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Effect of Prehospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients

Abstract: phRTx was associated with increased survival to hospital, but not overall survival. The "delay death" effect of phRTx carries an impetus to further develop in-hospital strategies to improve survival in severely bleeding patients.

Cited by 86 publications

References 34 publications

The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

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

In silico model of the dilutional effects of conventional component therapy versus whole blood in the management of massively bleeding adult trauma patients

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