Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-25T05:12:33.941Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Leif Rognås ,
Mads Vandborg ,
Christian Erikstrup  and
Christian Fenger-Eriksen Open the ORCID record for Christian Fenger-Eriksen [Opens in a new window]
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

hemorrhageprehospital careprehospital transfusion
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 2 , April 2021 , pp. 170 - 174
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Griggs, JE, Jeyanathan, J, Joy, M, et al. Mortality of civilian patients with suspected traumatic hemorrhage receiving prehospital transfusion of packed red blood cells compared to prehospital crystalloid. Scand J Trauma Resusc Emerg Med. 2018;26(1):100.CrossRefGoogle Scholar
Shaz, BH, Winkler, AM, James, AB, Hillyer, CD, MacLeod, JB. Pathophysiology of early trauma-induced coagulopathy: emerging evidence for hemodilution and coagulation factor depletion. J Trauma. 2011;70(6):1401-1407.Google ScholarPubMed
Jansen, JO, Thomas, R, Loudon, MA, Brooks, A. Damage control resuscitation for patients with major trauma. BMJ. 2009;338:b1778 CrossRefGoogle ScholarPubMed
Sheppard, FR, Schaub, LJ, Cap, AP, et al. Whole blood mitigates the acute coagulopathy of trauma and avoids the coagulopathy of crystalloid resuscitation. J Trauma Acute Care Surg. 2018;85(6):1055-1062.CrossRefGoogle ScholarPubMed
Curry, N, Davis, PW. What’s new in resuscitation strategies for the patient with multiple trauma? Injury. 2012;43(7):1021-1028.CrossRefGoogle ScholarPubMed
Holcomb, JB, Donathan, DP, Cotton, BA, et al. Prehospital transfusion of plasma and red blood cells in trauma patients. Prehosp Emerg Care. 2015;19(1):1-9.CrossRefGoogle ScholarPubMed
Brown, JB, Sperry, JL, Fombona, A, Billiar, TR, Peitzman, AB, Guyette, FX. Pre-Trauma center red blood cell transfusion is associated with improved early outcomes in air medical trauma patients. J Am Col Surg. 2015;220(5):797-808.CrossRefGoogle ScholarPubMed
Moore, HB, Moore, EE, Chapman, MP, et al. Plasma-First resuscitation to treat hemorrhagic shock during emergency ground transportation in an urban area: a randomized trial. Lancet. 2018;392(10144):283-291.CrossRefGoogle Scholar
Naumann, DN, Doughty, H, Cotton, BA. No gains with plasma-first resuscitation in urban settings? Lancet. 2018;392(10144):255-256.CrossRefGoogle ScholarPubMed
Rognås, L, Hansen, TM, Kirkegaard, H, Tønnesen, E. Pre-Hospital advanced airway management by experienced anesthesiologists: a prospective descriptive study. Scand J Trauma Resurc Emerg Med. 2013;(21):58.CrossRefGoogle Scholar
Lyon, RM, de Sausmarez, E, McWhirter, E, et al. Prehospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service. Scand J Trauma Resusc Emerg Med. 2017;25(1):12.CrossRefGoogle Scholar
Spahn, DR, Bouillon, B, Cerny, V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23(1):98.CrossRefGoogle ScholarPubMed