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

Abstract

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

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial

“…15 A 2020 review of prehospital red blood cell transfusion highlighted the absence of randomised trials and was unable to demonstrate a survival benefit, but recommended further studies with plasma and individualised transfusion criteria. 16 Extending the use of both packed red blood cells (PRBC) and plasma for major haemorrhage into the prehospital environment might seem intuitive but has implications for the transfusion and clinical communities. Transfusion specific concerns include sustaining the demand for universal blood products, blood product wastage, and regulatory compliance.…”

Initial experiences of prehospital blood product transfusions between 2016-2020 in Päijät-Häme hospital district, Finland

“…Some of the reported reactions have been connected to fresh frozen plasma transfused in the hospital [10,20]. PHBT can decrease trauma patients need for blood products during the rst 24h of care [5,7,8,9] and this can potentially decrease patients allogeneic tissue exposure and optimize the use of limited resource [7]. In our study, no transfusion-related severe adverse events were noted during or after prehospital phase.…”

Präklinische Therapie mit Blutprodukten – das Projekt „HeliBlut“

“…Analog zur innerklinischen Erstversorgung wurden daher im Verlauf auch präklinisch Plasmapräparate eingesetzt [19,20,21,22]. Die kombinierte Gabe von Erythrozytenkonzentraten und Plasma scheint den größten Vorteil zu bieten, ebenso die Gabe bei Transportzeiten von mehr als 20 Minuten [19].…”