What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study

Abstract

ObjectivesWe investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority.SettingThe Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services. Each was invited to provide up to 5 years of data and total number of taskings during the same period.ParticipantsPatients with hypotensive trauma (systolic blood pressure <90 mm Hg or absent radial pulse) attended by a doctor.Primary and secondary outcome measuresThe primary outcome was the number of patients with hypotensive trauma given prehospital fluids. Secondary outcomes were types and volumes of fluids. These data were combined with published data to estimate potential national eligibility for PHBP.ResultsOf 29 037 taskings, 729 (2.5%) were for patients with hypotensive trauma attended by a physician. Half were aged 21–50 years; 73.4% were male. A total of 537 out of 729 (73.7%) were given fluids. Five hundred and ten patients were given a single type of fluid; 27 received >1 type. The most common fluid was 0.9% saline, given to 486/537 (90.5%) of patients who received fluids, at a median volume of 750 (IQR 300–1500) mL. Three per cent of patients received PHBP. Estimated projections for patients eligible for PHBP at these 11 services and in the whole UK were 313 and 794 patients per year, respectively.ConclusionsOne in 40 air ambulance taskings were manned by physicians to retrievepatients with hypotensive trauma. The most common fluid delivered was 0.9% saline. If evidence justifies universal provision of PHBP, approximately 800 patients/year would be eligible in the UK, based on our data combined with others published. Prospective investigations are required to confirm or adjust these estimations.

Vox Sanguinis International Forum on the use of prehospital blood products and pharmaceuticals in the treatment of patients with traumatic hemorrhage

“…In the RESCUER study, we demonstrated that the time interval between the emergency call and arrival of the medical team was 25 (IQR 19–35 min). The median combined on‐scene and transfer time was 53 min (IQR 39–73)…”

“…The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) study explored the use of fluids used following hypotensive trauma in physician‐led prehospital care. We showed that, at that time, ten services carried blood and four of these had already published data …”

“…Of these, 73.4% were given fluids and only 3% received prehospital blood products. The most common fluid delivered was 0.9% saline . The data were used to scope potential national prehospital blood requirements.…”

“…Not currently applicable. However, we noted in the RESCUER study that the majority (75–80%) of patients treated by the air ambulances were male and therefore eligible for O positive red cells or whole blood …”

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

“…Three out of seven services had immediate access to PHTRBC; the other four needed 45 minutes in order to obtain it. Karl et al report that 25.3% of 235 US Helicopter Emergency Medical Service (HEMS) programmes that responded to a survey carried blood, while a 2016 survey found that 10 out of the 22 HEMS in the United Kingdom carried blood products …”