Out-of-hospital blood administration for critically injured patients transported by helicopter

Red Blood Cell Transfusion: Experience in a Rural Aeromedical Transport Service

“…4 Eighty-four percent of our study subjects either died in the receiving institution's Emergency Department or were immediately transferred to an operating theater or critical care unit, with an overall in-hospital mortality rate of 31%.…”

“…[1][2][3][4][5] Blood transfusion appears to be a low volume intervention during aeromedical patient transport. Review of these reports, combined with the results of this study, allows for several general observations.…”

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

“…Studies comparing vital parameters in PHTRBC patients vs non‐receivers report conflicting results: significantly lower occurrence of hypotension, a higher DBP, and a higher BE and pH have been reported in PHTRBC patients, but in contrast, significantly lower SBP, a higher HR, a lower pH and a lower bicarbonate level have also been found. Other studies found no significant differences in either SBP, DBP, HR, BE, lactate, change in mean BP or in HR or occurrence of “shock on admission.” Kim et al compared PHTRBC with PHTRBC + PHT‐plasma and found no significant differences in SBP, HR, lactate, BE or pH. Brown et al measured base deficit and lactate levels on arrival to hospital, and used these to calculate the odds of shock.…”

“…However, in six other studies reporting matched or adjusted data, no significant effect on mortality was found, either at 3 hours, 6 hours, 24 hours, 28 days or 30 days post‐infusion, for in‐hospital mortality or overall mortality (Table ). Conversely, Kim et al found significantly lower mortality at 24 hours and a lower mortality overall for patients transfused with both PHT‐plasma and PHTRBC compared with patients receiving PHTRBC only.…”

“…Five analyses found the RBC requirement in‐hospital or in the first 24 hours to be significantly higher for PHTRBC patients, whereas five others found it to be significantly lower . One of these studies noted that taking the prehospital transfused volume into account, the cumulative 24 hours RBC requirement was not significantly different .…”