Prehospital Whole Blood Transfusion Programs in Norway

Abstract

<b><i>Background:</i></b> Prehospital management of severe hemorrhage has evolved significantly in Norwegian medical emergency services in the last 10 years. Treatment algorithms for severe bleeding were previously focused on restoration of the blood volume by administration of crystalloids and colloids, but now the national trauma system guidelines recommend early balanced transfusion therapy according to remote damage control resuscitation principles. <b><i>Materials and Methods:</i></b> This survey describes the implementation, utilization, and experience of the use of low titer group O whole blood (LTOWB) and blood components in air ambulance services in Norway. Medical directors from all air ambulance bases in Norway as well as the blood banks that support LTOWB were invited to participate. <b><i>Results:</i></b> Medical directors from all 13 helicopter emergency medical services (HEMS) bases, the 7 search and rescue (SAR) helicopter bases, and the 4 blood banks that support HEMS with LTOWB responded to the survey. All HEMS and SAR helicopter services carry LTOWB or blood components. Four of 20 (20%) HEMS bases have implemented LTOWB. A majority of services (18/20, 90%) have a preference for LTOWB, primarily because LTOWB enables early balanced transfusion and has logistical benefits in time-critical emergencies and during prolonged evacuations. <b><i>Conclusion:</i></b> HEMS services and blood banks report favorable experiences in the implementation and utilization of LTOWB. Prehospital balanced blood transfusion using whole blood is feasible in Norway.

The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results

“…8,9 In the prehospital setting, with only one blood product to store and administer, WBT is simpler than component therapy, which may not be feasible for some Emergency Medical Service (EMS) systems. Indeed, some other countries, including Norway 10,11 and Israel, 12 and some other locations within the United States, including San Antonio, Texas 13 and Pittsburgh, Pennsylvania, 14,15 have been using WBTs for years. Data from these systems have suggested that prehospital WBT is safe and may even improve survival.…”

The Norwegian blood preparedness project: A whole blood program including civilian walking blood banks for early treatment of patients with life‐threatening bleeding in municipal health care services, ambulance services, and rural hospitals

“…[9][10][11][12][13][14] Today, LTOWB is implemented in routine use for civilian and military prehospital air ambulance services, in a large trauma center, and in four local hospitals in Norway. 13,15,[16][17][18] We have previously described our experience with whole blood based blood preparedness programs for a level 1 trauma hospital and for small rural hospitals with limited blood inventories. 16,18 However, bad weather conditions and long transport distances, especially in the Northern part of Norway, may limit access to emergency health care support and delay medical evacuation.…”

“…Low titer group O whole blood (LTOWB) are used for treatment of bleeding patients because it offers plasma, red cells and platelets in a balanced ratio in a logistical advantageous way 9–14 . Today, LTOWB is implemented in routine use for civilian and military prehospital air ambulance services, in a large trauma center, and in four local hospitals in Norway 13,15,16–18 . We have previously described our experience with whole blood based blood preparedness programs for a level 1 trauma hospital and for small rural hospitals with limited blood inventories 16,18 .…”

Transfusion-related cost comparison of trauma patients receiving whole blood versus component therapy

“…Literature supporting a balanced resuscitation (1:1:1 ratio of PRBC to FFP to PLT) has led to the increased use of WB for resuscitation of patients in hemorrhagic shock, and there is literature showing the difficulties encountered in maintaining balanced resuscitation, especially in massive transfusion (MT) scenarios 2,3 . Since 2017, multiple studies have demonstrated the benefit of using WB as a resuscitation strategy for hemorrhagic shock 4–8 . However, few studies have evaluated the costs associated with WB transfusion 9,10 .…”

“…2,3 Since 2017, multiple studies have demonstrated the benefit of using WB as a resuscitation strategy for hemorrhagic shock. [4][5][6][7][8] However, few studies have evaluated the costs associated with WB transfusion. 9,10 We hypothesize that WB transfusion is associated with reduced transfusion-related costs compared with component therapy (CT).…”