Prehospital transfusion of low titer cold‐stored whole blood through the intraosseous route in a trauma patient with hemorrhagic shock

Abstract

BACKGROUND Damage control resuscitation, avoidance of dilutional coagulopathy, and increased blood component therapy reduce mortality after major trauma hemorrhage. Improved outcomes seen in recent warfare have placed whole blood as the preferred product for resuscitation of severe traumatic hemorrhage. As of 2018, flight physicians of the Israeli Airborne Combat Search and Rescue Unit (ACSRU) treat these patients with low titer cold‐stored O‐positive whole blood (LTCSO+WB). Intraosseous (IO) is the preferred route if intravenous access is not available. To date, no study has described the administration of LTCSO+WB via the IO route in the prehospital setting. CASE REPORT We present a case of whole blood transfusion via the IO route in a 30‐year‐old car accident patient who suffered major injuries and developed severe hemorrhagic shock. Intravenous access could not be obtained at the scene. En route, two units of LTCSO+WB were administered, using an IO hand drill, and the patientʼs hemodynamic status improved. The patient survived the injury with a good outcome. CONCLUSION This is the first report of whole blood infusion via the IO route in traumatic hemorrhagic shock in the prehospital setting. Our positive experience suggests that this approach may have a role in hemorrhagic trauma patients when intravenous access cannot be obtained.

The relationship between intraosseous catheter tip placement, flow rates, and infusion pressures in a high bone density cadaveric swine (Sus scrofa) model

“…We utilized a push‒pull infusion technique with a 60 mL syringe because prior research has demonstrated that pressure rarely exceeds 4000 mmHg with this technique and because this technique is currently used by a variety of prehospital medical teams. 30 , 34 …”

Resuscitation and Evaluation With Intraosseous Access: A Review of the Literature in Trauma and Non-Trauma Patients

“…Of the 41 overall eligible studies, 19 articles exclusively included trauma patients. 9,18,24,28,31,[35][36][37]41,42,[45][46][47]49,53,[56][57][58]60 Most of these studies were case reports, followed by 4 retrospective studies and 3 prospective observational studies. Only 4 of the trauma studies reported success rates by IO device, with the highest being 100% success using the FAST1, followed by 97% using the EZ-IO.…”

Factors Influencing Blood Donation Practice Among Health Care Providers of Public Hospitals in Bahir Dar City, North West Ethiopia: A Case Control Study

“…Pregnant women, cancer patients, and individuals with an illness that causes anemia often have very important transfusion needs, which complicate a blood crisis because these patients require components or specific blood products. 16 , 17 Patients who have experienced serious injuries from car crashes, 18 when the demand for blood is too high, anemia leads to significant morbidity and mortality. 7 …”