Pre-hospital transfusion of post-traumatic hemorrhage: Medical and regulatory aspects

Labarthe, Adrienne de; Mennecart, Thibaut; Imfeld, Carola; Lély, P.; Ausset, Sylvain

doi:10.1016/j.tracli.2021.08.345

Cited by 2 publications

(3 citation statements)

References 47 publications

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“…French regulations concerning labile blood products require that they be stored inside a centralized deposit under the responsibility of the French Blood Institute 8 . SMURs, which do not have a deposit status, are not authorized to store blood products.…”

Section: Methodsmentioning

confidence: 99%

Use of prehospital transfusion by French emergency medical services: A national survey

Bichot

Pasquier²,

Martinaud

et al. 2023

Transfusion

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Background Major bleeding is the leading cause of preventable mortality among trauma patients. Several studies have recently shown that prehospital plasma transfusion improves the outcomes of severely injured patients. Although no consensus has been reached, prehospital transfusion is regularly considered to reduce avoidable mortality. The objective was to assess the status of prehospital transfusion practices in France. Study Design and Methods A national survey among the 378 advance life support emergency teams (SMURs) in metropolitan France was conducted from December 15, 2020 to October 31, 2021. A questionnaire was distributed by e‐mail to the physicians in charge of SMURs. The questions addressed the transfusion modalities, labile blood products (LBPs) used, and limitations encountered in implementing transfusion. Results The response rate was 48%, and 82% of the respondents performed prehospital transfusions. A designated pack was used by 44% of the respondents. The LBPs used were packed red blood cells (100%), of which 95% were group 0 RH:‐1, fresh frozen plasma (27%), lyophilized plasma (7%), and platelets (1%). The LBPs were transported in isothermal boxes (97%) without temperature monitoring in 52% of the cases. Nontransfused LBPs were discarded in 43% of the cases. Reported limitations in implementing transfusion were the delivery time (45%), loss of LBPs (32%), and lack of evidence (46%). Discussion Prehospital transfusion was developed in France but access to plasma remains difficult. Protocols allowing the reutilization of LBPs and improving conservation could limit the waste of a rare resource. Implementing the use of lyophilized plasma could facilitate prehospital transfusion. Future studies will need to specify the role of each LBP in the prehospital setting.

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Section: Methodsmentioning

confidence: 99%

Use of prehospital transfusion by French emergency medical services: A national survey

Bichot

Pasquier²,

Martinaud

et al. 2023

Transfusion

View full text Add to dashboard Cite

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“…7,8 Since France's tainted blood scandal in the 1980s, 9 France has passed strict laws regulating transfusion policy, which do not currently provide any derogation for prehospital transfusion. 10 All these requirements are difficult for a mobile emergency medical service to meet (Table 1). [11][12][13][14] In conjunction with the French Military Blood Institute (FMBI), the PFB is currently implementing mobile blood depots within its physician-staffed ambulances, in compliance with the French legislation.…”

Section: Introductionmentioning

confidence: 99%

“…The intended strategies not only had to meet the logistical challenges, but also had to respect the particularly stringent French legislation on blood bank functioning and blood transfusion 7,8 . Since France's tainted blood scandal in the 1980s, 9 France has passed strict laws regulating transfusion policy, which do not currently provide any derogation for prehospital transfusion 10 . All these requirements are difficult for a mobile emergency medical service to meet (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

et al. 2023

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BackgroundPrehospital transfusion is a way of improving the management of hemorrhagic shock. In France, prehospital transfusion is struggling to develop, both because of logistical difficulties and particularly restrictive legislation. To comply with this, we propose to store the blood products (BPs) in ground ambulances with refrigerated boxes allowing remote continuous monitoring of storage conditions, called “NelumBox” (Tec4med Lifescience GmbH). To open them, the ambulance's team needs a code that is only given by the Transfusion Center if the request meets all required regulatory criteria.Study Design and MethodsWe conducted a prospective simulation‐based feasibility study using dummy BPs. Two ambulances were equipped. Simulations were triggered unexpectedly, including during on‐call hours. The ability to quickly access the BPs was the main judgment criterion. The quality of hemovigilance during these simulations was also examined.ResultsTwenty‐two simulations were performed. The ambulance's team was able to access the BPs in 100% of cases. The average waiting time for receiving the unlocking code was 5 min 27 s (SD = 2 min 12 s, MAX = 12 min 00 s). The transfusion traceability was compliant with regulations in 100% of cases. The transfusion center was able to remotely monitor BPs storage conditions for the entire duration of their stockage in the NelumBox.DiscussionThe present procedure is efficient, repeatable, and fast. It guarantees a strict transfusion safety without slowdown a severe trauma management, while complying with French regulations.

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Pre-hospital transfusion of post-traumatic hemorrhage: Medical and regulatory aspects

Cited by 2 publications

References 47 publications

Use of prehospital transfusion by French emergency medical services: A national survey

Use of prehospital transfusion by French emergency medical services: A national survey

Mobile blood depots in ground ambulances in compliance with French legislation: A feasibility study

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