This article is more than 5 years old. Information may no longer be current.
Blood transfusions during transport to trauma center improve survival
Click Here to Manage Email Alerts
Patients who received red blood cell transfusions on a helicopter prior to arrival at a trauma center demonstrated improved survival compared with those who did not receive transfusions until arrival in the trauma unit, according to study results.
“After matching patients for how badly they were injured at the scene, the people who received blood transfusions while they were on a helicopter were more likely to survive on the first day after being injured,” Joshua B. Brown, MD, a resident in the general surgery residency program at the University of Pittsburgh Medical Center, said in a press release.
Hemorrhage is the leading cause of death in trauma victims, and early transfusion of red blood cells can reduce the chance of death. However, the capability to provide such transfusions in-flight is limited to better-developed helicopter emergency medical service systems, according to study background.
Brown and colleagues conducted a retrospective cohort study of trauma patients transferred from a hospital by helicopter to a trauma center at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital between 2007 and 2012. They identified 240 patients treated with red blood cell (RBC) transfusions in flight and compared them with 480 control patients who did not undergo transfusion prior to arriving at the trauma center.
The researchers identified a subgroup of 213 patients transported directly from the scene of the trauma. Of these patients, 71 received blood transfusions and 142 did not.
“This subgroup of patients is of particular interest, as they had no opportunity to receive treatment or blood products prior to air medical crew interventions and transport and thus received true prehospital RBC transfusion,” the researchers wrote.
Survival at 24 hours served as the study’s primary outcome. Secondary endpoints included shock upon admission, 24-hour in-hospital red blood cell transfusion volume, trauma-induced coagulopathy and in-hospital survival.
Patients who received transfusions during transfer from another hospital appeared five times as likely to survive 24 hours (adjusted OR = 4.92; 95% CI, 1.51-16.04). They also demonstrated a 72% (aOR = 0.28; 95% CI, 0.09-0.85) reduction in risk for shock.
Additionally, 24-hour transfusion volume decreased by more than 3 units of blood (Coef – 3.6 RBC units; 95% CI, – 7 to – 0.2) compared with patients who did not undergo transfusions.
Patients transported directly from the scene of trauma were more than six times more likely than those who did not receive a transfusion to survive 24 hours (aOR = 6.31; 95% CI. 1.88-21.14). They also demonstrated a 76% reduction in risk for shock upon hospital admission (aOR = 0.24; 95% CI, 0.07-0.8) and decreased transfusion volume of more than 4 units of blood in a 24-hour span (Coef – 4.5 RBC units; 95% CI, – 8.3 to – 0.7).
Researchers observed no association between in-flight transfusions and trauma-induced coagulopathy or in-hospital survival.
UPMC updated its protocol based on the study results, Brown said.
“These data further support the use of pre-trauma center red blood cell transfusion in severely injured air medical trauma patients,” Brown and colleagues concluded. “Prospective study of this issue is warranted as blood products become more readily available for prehospital resuscitation and may lead to improved outcomes in the severely injured patient in shock.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopEduardo Gonzalez, MD and Christopher C. Silliman, MD, PhD
Eduardo Gonzalez
Christopher C. Silliman
Brown and colleagues reported that transfusion of red blood cells (RBCs) to injured patients during helicopter transport was independently associated with improved adjusted odds of 24-hour survival, with decreased shock on admission, and with reduction in RBC transfusion volume in the first 24 hours compared with those who did not receive a pre-hospital transfusion. In a subgroup analysis of 213 patients transported directly from the scene, a similar association was determined in transfused patients vs. non-transfused patients for the same adjusted-odds outcomes. There was no difference in the development of trauma-induced coagulopathy or in-hospital survival between transfused and non-transfused patients.
One of the concerns for pre-hospital transfusion programs is the transfusion of patients who, if assessed in the ED, would not require transfusion, and can studies such as this one identify such patients in the treated cohort? Moreover, the patients in this study were relatively older (median age, 49 years) for all groups vs. similar studies of injured patients.
Although there was no difference in acute respiratory distress syndrome between groups, was the study adequately powered for this determination? Furthermore, it is unclear why some patients were transfused and some were not based upon the propensity-matched cohort methodology. Lastly, RBCs provide increased oxygen carrying capacity and volume expansion, and the transfused group received one unit (median) of packed RBCs (3 mL/kg to 6 mL/kg). Colloids may efficiently expand volume more than expected, and the results of the Department of Defense pre-hospital plasma infusion trial may confirm this. In addition, pre-hospital RBC transfusion may alleviate ischemia-reperfusion injury, although this needs to be proven.
Importantly, patients with intermediate injury severity score (median, 17-22) may respond better to RBC transfusion than the more severely injured, especially those who require massive transfusion. Further studies are needed to determine if pre-hospital transfusion: RBCs, plasma or both, are crucial for optimal survival.
Click Here to Manage Email Alerts