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Prehospital Transfusion of Red Blood Cells and Plasma by an Urban Ground-Based Critical Care Team

Published online by Cambridge University Press:  22 December 2020

Karoline Sætre Michalsen*
Affiliation:
Prehospital Emergency Medical Service, Aarhus, Central Denmark Region, Denmark
Leif Rognås
Affiliation:
Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
Mads Vandborg
Affiliation:
Department of Anaesthesiology, Viborg Regional Hospital, Viborg, Denmark
Christian Erikstrup
Affiliation:
Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
Christian Fenger-Eriksen
Affiliation:
Prehospital Emergency Medical Service, Aarhus, Central Denmark Region, Denmark Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
*
Correspondence: Karoline Sætre Michalsen, Prehospital Emergency Medical Service, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark, E-mail: karoline.mic@outlook.com

Abstract

Introduction:

Prehospital blood component therapy poses a possible treatment option among patients with severe bleeding. The aim of this paper was to characterize patients receiving prehospital blood component therapy by a paramedic-doctor-staffed, ground-based prehospital critical care (PHCC) service.

Methods:

Bleeding patients with a clinical need for prehospital blood transfusion were included prospectively. The following data were collected: indication for transfusion, mechanism of injury, vital parameters, units of red blood cells (RBCs)/plasma transfused, degree of shock, demographics, and mortality.

Results:

Twenty-one patients received blood products: 12 (57%) traumatic injuries and nine (43%) non-traumatic bleeds, with a median of 1.5 (range 1.0-2.0) units of RBCs and 1.0 (range 0.0-2.0) unit of plasma. The most frequent trigger to initiate transfusion was on-going excessive bleeding and hypotension. Improved systolic blood pressure (SBP) and milder degrees of shock were observed after transfusion. Mean time from initiation of transfusion to hospital arrival was 24 minutes. In-hospital, 11 patients (61%) received further transfusion and 13 (72%) had urgent surgery within 24 hours. Overall, 28-day mortality was 29% at 24-hours and 33% at 28-days.

Conclusion:

Prehospital blood component therapy is feasible in a ground-based prehospital service in a medium-sized Scandinavian city. Following transfusion, patient physiology and degree of shock were significantly improved.

Type
Original Research
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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