Abstract 4: Initial Results for Pre-Hospital Transfusion of Plasma and RBCs in Trauma Patients
Introduction: Earlier use of plasma has been associated with improved survival in trauma patients with substantial hemorrhage. In September 2011 we placed 2 units each of thawed plasma and RBCs on our helicopters. We hypothesized that pre-hospital transfusion (PHT) of thawed plasma and/or RBCs would result in improved patient coagulation status on admission and survival.
METHODS: Adult trauma patient records were reviewed for patient demographics, shock, coagulopathy, outcomes and blood product utilization from Sept 2011-Dec 2012. Patients arrived by either ground or two different helicopter companies. All patients transfused blood products (either pre or in-hospital) were included in the study. One helicopter system had thawed plasma and RBCs while the other air and ground transport systems used only crystalloid resuscitation. Patients receiving PHT were compared with all other patients meeting entry criteria to the study cohort. All comparisons were adjusted in multi-level regression models.
Results: 6238 adult trauma patients were admitted during the 15 month study period, of which 577 (9.2%) met inclusion criteria. They represented the most severely injured patients (ISS = 24 and mortality = 26%). There were 97 patients who received PHT and 480 in the non PHT control group. 244 units of RBCs and 698 units of plasma were placed on the helicopters, with 1.9% wastage. PHT was associated with reduced risks of 6-hour mortality (adjusted OR=0.08, 95% CI=0.01-0.87, p=0.04) and coagulopathy on arrival (TEG ACT ≥ 128, (adjusted OR=0.40, 95% CI=0.19-0.87, p=0.02) and a 13% non-significant improvement in hospital mortality.
CONCLUSION: Prehospital plasma and RBC transfusion was associated with improved coagulation status and a reduction in the risk of death in the first 6 hours after admission, with negligible blood products wastage.
- © 2013 by American Heart Association, Inc.