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

Abstract

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

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

“…The search in PubMed and Web of Science yielded 2172 hits after removal of duplicates. In our scoping review, 71 articles were included . In total, 55 of these studies reported one or more outcome measure, and were included in this review (Figure ).…”

“…PubMed and Web of Science were searched through January 2019. The search strategy and the process of selection of studies were described previously . For the purpose of this systematic review, only the manuscripts reporting outcome measures after PHTRBC (data on the hemodynamic state, coagulopathy, 24 hours RBC transfusion requirement, length of stay in hospital/intensive care unit [ICU], mortality, or occurrence of complications) were included.…”

“…In part 1 of this series, we described the availability and frequency of PHTRBC around the world, and demonstrated that varying transfusion criteria are being used . However, to date, little is known concerning the effects on patient outcomes.…”

Pre‐hospital transfusion: Trials and tribulations

“…In this edition, we present a two‐part review of the use of red cells in pre‐hospital care from van Turenhout et al, a Dutch clinical team. The first part reviews current practice including the transfusion triggers to treat . The second paper is a systematic review of pre‐hospital red cell transfusion on clinical outcomes .…”

Temperature mapping in an air ambulance helicopter: Implications for the delivery of pre‐hospital transfusion

“…Pre‐hospital blood products (PHBPs), including freeze‐dried plasma, are increasingly carried on air ambulance helicopters in the United Kingdom 1 . In other countries, 25% of programs currently carry blood, although others have stopped owing to logistical challenges 2 . The helicopter working environment has more noise, vibration, and greater temperature extremes than that of ground emergency medical services (GEMS).…”