Emergency Transfusion During Medical Air Transport: Development of an Off-Site Storage and Transfusion Program

Krugh, Dave; Carmen, Julius; Quinlin, Bill; Counts, Frank; Hill, Kelly; Kertis, Randy; Blazina, Janice

doi:10.1093/labmed/25.5.318

Cited by 2 publications

(7 citation statements)

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“…Data on non‐trauma patients were reported in 16 civilian studies and made up 3% to 100% of these study cohorts . Suspected gastro‐intestinal bleeding or ruptured aortic aneurysm were the most often reported non‐traumatic diagnoses in transfused patients.…”

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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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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show abstract

“…For civilian EMS that transfuse blood prior to hospital arrival, their overall pre‐hospital transfusion rates vary from 0.2 to 4.4% of patients, without evident differences between interfacility transport and primary transport from the scene (0.7‐6.2% vs 4.9). For the overall population of trauma patients, transfusion rates ranging from 3.0% to 3.5% were reported with transfusion occurring in 1.6% to 7.5% of trauma scene transports and in 4.8% to 30% of interfacility transports .…”

Section: Resultsmentioning

confidence: 99%

“…In patients treated by a civilian EMS, 5 studies reported a mean/median of 1 unit transfused, 17 studies report a mean/median of 1.1 to 2 units (or between 280 and 560 mL) and 8 studies reported a mean/median of 2.3 to 3 units transfused (or between 560 and 840 mL) . Paediatric patients received a mean of 9.8 mL/kg or 255 mL (8 mL/kg) …”

Section: Resultsmentioning

confidence: 99%

“…Figure shows the most common criteria for PHTRBC in adults by civilian services as reported by 20 unique groups. The most commonly reported criteria are follows: hypotension, tachycardia, clinical signs of poor perfusion, type of injury (ie, ongoing bleeding or penetrating wounds) or a clinician's judgement . Not all groups explained their definition of “hypotension” or described which clinical signs were considered to indicate a state of poor perfusion.…”

Section: Resultsmentioning

confidence: 99%

“…In the case of interfacility transport, three groups explained that they would continue a transfusion started by the referring hospital (a major criterion), and one group used a haemoglobin concentration reported by the referring hospital as a transfusion trigger (also a major criterion) . Interestingly, 10 groups required the administration of crystalloids before their criteria would prompt transfusion …”

Section: Resultsmentioning

confidence: 99%

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Pre‐hospital transfusion of red blood cells. Part 1: A scoping review of current practice and transfusion triggers

Turenhout

Bossers

Loer

et al. 2020

Transfusion Medicine

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Objectives: The primary aim of this scoping review is to describe the current use of pre-hospital transfusion of red blood cells (PHTRBC) and to evaluate criteria used to initiate PHTRBC. The effects on patients' outcomes will be reviewed in Part 2.Background: Haemorrhage is a preventable cause of death in trauma patients, and transfusion of red blood cells is increasingly used by Emergency Medical Services (EMS) for damage control resuscitation. However, there are no guidelines and little consensus on when to initiate PHTRBC.Methods: PubMed and Web of Science were searched through January 2019; 71 articles were included.Results: Transfusion triggers vary widely and involve vital signs, clinical signs of poor tissue perfusion, point of care measurements and pre-hospital ultrasound imaging. In particular, hypotension (most often defined as systolic blood pressure ≤ 90 mmHg), tachycardia (most often defined as heart rate ≥ 120/min), clinical signs of poor perfusion (eg, prolonged capillary refill time or changes in mental status) and injury type (ie, penetrating wounds) are common pre-hospital transfusion triggers.Conclusions: PHTRBC is increasingly used by Emergency Medical Services, but guidelines on when to initiate transfusion are lacking. We identified the most commonly used transfusion criteria, and these findings may provide the basis for consensus-based pre-hospital transfusion protocols.damage control resuscitation, emergency medical service, major haemorrhage, pre-hospital transfusion, red blood cells, transfusion criteria

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Emergency Transfusion During Medical Air Transport: Development of an Off-Site Storage and Transfusion Program

Cited by 2 publications

References 0 publications

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

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

Pre‐hospital transfusion of red blood cells. Part 1: A scoping review of current practice and transfusion triggers

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