Prehospital blood transfusion: who benefits?

Thies, Karl-Christian; Ruetzler, Kurt

doi:10.1016/s2352-3026(22)00074-6

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…The volume and infusion speed of fluids administered prior to diagnostics is reduced, aiming for a period of permissive hypotension ( 43 ). Furthermore and following the rationale of prompt haemostatic resuscitation (administration of blood products), transfusion protocols during the transfer of bleeding trauma patients to the hospital have been introduced ( 44 , 45 ).…”

Section: Key Elements At the Prehospital Phasementioning

confidence: 99%

Severely injured patients: modern management strategies

et al. 2023

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Management of severely injured patients remains a challenge, characterised by a number of advances in clinical practice over the last decades. This evolution refers to all different phases of patient treatment from prehospital to the long-term rehabilitation of the survivors. The spectrum of injuries and their severity is quite extensive, which dictates a clear understanding of the existing nomenclature. What is defined nowadays as polytrauma or major trauma, together with other essential terms used in the orthopaedic trauma literature, is described in this instructional review. Furthermore, an analysis of contemporary management strategies (early total care (ETG), damage control orthopaedics (DCO), early appropriate care (EAC), safe definitive surgery (SDS), prompt individualised safe management (PRISM) and musculoskeletal temporary surgery (MuST)) advocated over the last two decades is presented. A focused description of new methods and techniques that have been introduced in clinical practice recently in all different phases of trauma management will also be presented. As the understanding of trauma pathophysiology and subsequently the clinical practice continuously evolves, as the means of scientific interaction and exchange of knowledge improves dramatically, observing different standards between different healthcare systems and geographic regions remains problematic. Positive impact on the survivorship rates and decrease in disability can only be achieved with teamwork training on technical and non-technical skills, as well as with efficient use of the available resources.

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Section: Key Elements At the Prehospital Phasementioning

confidence: 99%

Severely injured patients: modern management strategies

et al. 2023

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“…Bei der Fallzahlkalkulation der RePhill-Studie fällt die antizipierte Inzidenz des primären Endpunkts von 10 % in der Interventionsgruppe bzw. 20 % in der Kontrollgruppe auf: Dies entspräche einer relativen Risikoreduktion von 50 %, was bei einer Zielgröße wie der Mortalität (die ohnehin zahlreichen Einflussfaktoren unterliegt) als sehr ambitioniert erscheint [ 34 ]. Auch der zusammengesetzte Endpunkt aus einem klinisch relevanten Parameter und einem Surrogatparameter unklarer Signifikanz kann kritisch hinterfragt werden [ 34 ].…”

Section: Prähospitale Transfusion Von Blut Und Blutersatzprodukten – ...unclassified

Fokus Notfallmedizin 2021/2022 – Zusammenfassung ausgewählter notfallmedizinischer Studien

et al. 2023

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“…alloimmunization), and resource requirements, questions remain and debate continues. 2,5,6 Issues surrounding CivPHT are being actively addressed by ongoing randomized trials such as the Type O Whole Blood and Assessment of Age During Prehospital Resuscitation (TOWAR, clini caltr ials. gov 04684719).…”

Section: Introductionmentioning

confidence: 99%

“…With regard to CivPHT patient eligibility, components (and ratios), complications (e.g. alloimmunization), and resource requirements, questions remain and debate continues 2,5,6 …”

Section: Introductionmentioning

confidence: 99%

Assessing the one‐month mortality impact of civilian‐setting prehospital transfusion: A systematic review and meta‐analysis

Schoenfeld,

Rosen,

Harris

et al. 2024

Academic Emergency Medicine

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BackgroundBased on convincing evidence for outcomes improvement in the military setting, the past decade has seen evaluation of prehospital transfusion (PHT) in the civilian emergency medical services (EMS) setting. Evidence synthesis has been challenging, due to study design variation with respect to both exposure (type of blood product administered) and outcome (endpoint definitions and timing). The goal of the current meta‐analysis was to execute an overarching assessment of all civilian‐arena randomized controlled trial (RCT) evidence focusing on administration of blood products compared to control of no blood products.MethodThe review structure followed the Cochrane group's Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA). Using the Transfusion Evidence Library (transfusionevidencelibrary.com), the multidatabase (e.g. PubMed, EMBASE) Harvard On‐Line Library Information System (HOLLIS), and GoogleScholar, we accessed many databases and gray literature sources. RCTs of PHT in the civilian setting with a comparison group receiving no blood products with 1‐month mortality outcomes were identified.ResultsIn assessing a single patient‐centered endpoint—1‐month mortality—we calculated an overall risk ratio (RR) estimate. Analysis of three RCTs yielded a model with acceptable heterogeneity (I2 = 48%, Q‐test p = 0.13). Pooled estimate revealed civilian PHT results in a statistically nonsignificant (p = 0.38) relative mortality reduction of 13% (RR 0.87, 95% CI 0.63–1.19).ConclusionsCurrent evidence does not demonstrate 1‐month mortality benefit of civilian‐setting PHT. This should give pause to EMS systems considering adoption of civilian‐setting PHT programs. Further studies should not only focus on which formulations of blood products might improve outcomes but also focus on which patients are most likely to benefit from any form of civilian‐setting PHT.

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Prehospital blood transfusion: who benefits?

Cited by 5 publications

References 9 publications

Severely injured patients: modern management strategies

Severely injured patients: modern management strategies

Fokus Notfallmedizin 2021/2022 – Zusammenfassung ausgewählter notfallmedizinischer Studien

Assessing the one‐month mortality impact of civilian‐setting prehospital transfusion: A systematic review and meta‐analysis

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