Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis

Rijnhout, Tim W.H.; Wever, Kimberley E.; Marinus, Roy H.A.R.; Hoogerwerf, Nico; Geeraedts, L.M.G.; Tan, Edward

doi:10.1016/j.injury.2019.03.033

Cited by 54 publications

(63 citation statements)

References 52 publications

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“…Our evolving understanding of shock‐induced coagulopathy and endotheliopathy should inform the debate . Recent reviews of combined red cells and plasma‐based resuscitation arrived at similar conclusions. Two recent independent randomised clinical trials investigated pre‐hospital plasma for traumatic haemorrhage .…”

Section: Continuity Of Carementioning

confidence: 87%

Pre‐hospital transfusion: Trials and tribulations

Doughty

Naumann

2020

Transfusion Medicine

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Section: Continuity Of Carementioning

confidence: 87%

Pre‐hospital transfusion: Trials and tribulations

Doughty

Naumann

2020

Transfusion Medicine

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“…Results on overall mortality are conflicting, and we found no consistent evidence for any effects of PHTRBC on survival. Recently, Rijnhout et al published a meta‐analysis on the effects of prehospital transfusion on mortality. In line with our results, these authors did not observe an effect of PHTRBC (without simultaneous transfusion of plasma) on mortality.…”

Section: Discussionmentioning

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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“…Transfusion reactions are not reported in the current study, but a recent systematic review indicates that the incidence of adverse reactions in PHBT is around 1%. (20). This is not surprising because major transfusion reactions (ABO incompatibility) are very unlikely, as blood group 0 is used for red cell transfusion in major haemorrhagic patients without previous blood group determination.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital blood transfusion – a survey on European practice

Thies

Truhlář

Keene

et al. 2020

Preprint

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Background Blood products are a lifesaving commodity in the treatment of major trauma. Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage. Aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The second aim was to evaluate opinions about PHBP and also the experience and the personal views of its users. Methods The subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d’Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries. Results In total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37% and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%. Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently. Conclusions We found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.

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Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis

Cited by 54 publications

References 52 publications

Pre‐hospital transfusion: Trials and tribulations

Pre‐hospital transfusion: Trials and tribulations

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

Pre-hospital blood transfusion – a survey on European practice

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