Red Blood Cell Transfusion: Experience in a Rural Aeromedical Transport Service

Higgins, George L.; Baumann, Michael R.; Kendall, Kevin; Watts, Michael A.; Strout, Tania D.

doi:10.1017/s1049023x12000659

Cited by 25 publications

(24 citation statements)

References 5 publications

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“…The use of PH RBCs ranged from 1.4% to 4.0%, with trauma patients comprising 48% to 71% of patients and scene transports 9% to 53%. 29–31 The proportion of scene transports in these series is consistent with the current analysis demonstrating 52% receiving PTC RBC transfusion were transported from the scene. In our matched cohort, however, three fourths of patients in each group were scene transports.…”

Section: Discussionsupporting

confidence: 82%

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Brown¹,

Cohen

Minei

et al. 2015

Annals of Surgery

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Objective To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01–0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15–0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02–0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01–0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03–0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01–0.95; P = 0.05). Conclusions PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

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Section: Discussionsupporting

confidence: 82%

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Brown¹,

Cohen

Minei

et al. 2015

Annals of Surgery

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“…Early studies demonstrated utilization of PTC RBC in a HEMS program required careful monitoring and defined arrangements with a blood bank, but overall was feasible and safe. (15, 16) As this practice became more common in HEMS programs, small studies emerged evaluating outcomes in trauma patients receiving PTC RBC transfusion. Sumida compared 17 patients receiving PTC RBC with 31 patients receiving more than 2L of crystalloid only.…”

Section: Discussionmentioning

confidence: 99%

“…(14) The capability to provide RBC transfusion during transport is generally limited to well-developed helicopter emergency medical service (HEMS) systems. (15, 16) Because of this, there is little evidence examining the use of prehospital RBC transfusion to mitigate early hemorrhage and shock in injured civilians. (17)…”

Section: Introductionmentioning

confidence: 99%

Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air Medical Trauma Patients

Brown

Sperry

Fombona

et al. 2015

Journal of the American College of Surgeons

153

126

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Background Hemorrhage is the leading cause of survivable death in trauma. Resuscitation strategies including early red blood cell (RBC) transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients. Study Design Retrospective cohort study of trauma patients transported by helicopter to a level-I trauma center, 2007—2012. Patients receiving PTC RBC transfusion were matched to control patients (receiving no PTC RBC transfusion during transport) in a 1:2 ratio using a propensity-score based on prehospital variables. Conditional logistic regression and mixed-effects linear regression were used to determine the association of PTC RBC transfusion with outcomes. Subgroup analysis was performed for scene transport patients. Results Two-hundred forty treatment patients were matched to 480 control patients receiving no PTC RBC transfusion. PTC RBC transfusion was associated with increased odds of 24-hour survival (adjusted odds ratio [AOR] 4.92; 95%CI 1.51, 16.04, p=0.01), lower odds of shock (AOR 0.28; 95%CI 0.09, 0.85, p=0.03), and lower 24-hour RBC requirement (Coef −3.6 RBC units; 95%CI −7.0, −0.2, p=0.04). Among matched scene patients, PTC RBC was also associated with increased odds of 24-hour survival (AOR 6.31; 95%CI 1.88, 21.14, p<0.01), lower odds of shock (AOR 0.24; 95%CI 0.07, 0.80, p=0.02), and lower 24-hour RBC requirement (Coef −4.5 RBC units; 95%CI −8.3, −0.7, p=0.02). Conclusions PTC RBC was associated with an increased probability of 24-hour survival, decreased risk of shock, and lower 24-hour RBC requirement. PTC RBC appears beneficial in severely injured air medical trauma patients and prospective study is warranted as PTC RBC transfusion becomes more readily available.

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“…Similarly, shorter time to transfusion has been associated with better survival . Positive experiences from the military setting have seen RCC administration adopted by civilian emergency medical systems …”

Section: Introductionmentioning

confidence: 99%

Prehospital transfusion of red cell concentrates in a paramedic‐staffed helicopter emergency medical service

Heschl

Andrew

Wit

et al. 2017

Emerg Medicine Australasia

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Red Blood Cell Transfusion: Experience in a Rural Aeromedical Transport Service

Cited by 25 publications

References 5 publications

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air Medical Trauma Patients

Prehospital transfusion of red cell concentrates in a paramedic‐staffed helicopter emergency medical service

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