Effect of Prehospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Rehn, Marius; Weaver, Anne; Brohi, Karim; Eshelby, Sarah; Green, Laura; Røislien, Jo; Lockey, David J.
• Is Part Of: Shock. Volume 51:Issue 3(2019)
• Publication Date: 2019-03
• Subjects: Emergency medical service -- erythrocyte transfusions -- injuries and wounds -- mortality -- ED -- emergency department -- HEMS -- helicopter emergency medical service -- LAA -- London's Air Ambulance -- MTC -- major trauma center -- PH -- prehospital -- phRTx -- red blood cell transfusion -- RBC -- red blood cell; Shock -- Periodicals; Shock -- Periodicals; Choc (Pathologie) -- Périodiques; Shock; Periodicals; 616.0475
• DOI: 10.1097/SHK.0000000000001166
• Languages: English
• ISSNs: 1073-2322

Abstract

ABSTRACT: Background: Current management principles of hemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's Air Ambulance (LAA) was the first UK civilian prehospital service to routinely offer prehospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality. Methods: Retrospective trauma database study comparing mortality before implementation with after implementation of phRTx in exsanguinating trauma patients. Univariate logistic regression was performed for the unadjusted association between phRTx and mortality was performed, and multiple logistic regression adjusting for potential confounders. Results: We identified 623 subjects with suspected major hemorrhage. We excluded 84 (13.5%) patients due to missing data on survival status. Overall 187 (62.3%) patients died in the before phRTx period and 143 (59.8%) died in the after phRTx group. There was no significant improvement in overall survival after the introduction of phRTx ( P = 0.554). Examination of prehospital mortality demonstrated 126 deaths in the pre-phRTx group (42.2%) and 66 deaths in the RBC administered group (27.6%). There was a significant reduction in prehospital mortality in the group who received RBC ( P < 0.001). Conclusions: phRTx was associated with increased survival to hospital, but not overall survival. The "delay death" effect of phRTx carries an impetus to further develop inhospital strategies to improve survival in severely bleeding patients.