Trauma is a major cause of death and disability. Among injured patients, death within 24 hours is primarily attributable to hemorrhage while many of these deaths are potentially preventable.
In order to increase the survival rate of bleeding patients, pre-hospital treatment focuses on early hemorrhage control where healthcare providers try to prevent hypovolemic shock and the lethal triad of acidosis, hypothermia and coagulopathy. For this reason, transfusion of red blood cells is increasingly used by Emergency Medical Services (EMS) for damage control resuscitation. The figures below describe the current use of pre-hospital transfusion of red blood cells (PHTRBC) during both primary transports from the scene and interfacility transports.
The overall pre-hospital transfusion for civilian EMS rates vary from 0.2 to 4.4% of all patients. There are noevident differences between interfacility transport and primary transport from the scene (0.7- 6.2% vs 4.9%). However, for the population of trauma patients, the overall transfusion rates range from 3.0% to 3.5% with transfusion occurring in 1.6% to 7.5% of trauma scene transports and in 4.8% to 30% of interfacility transports.
Cohorts with more severely injured patients (“highest risk population”) report transfusions being performed for 19% to 24% of patients. In military services, pre-hospital transfusion rates for more severely injured patients range from 25% to 32%.
[SUMMARY: PRE-HOSPITAL TRANSFUSION RATES]
TRANSFUSION RATES OF ALL PATIENTS IN CIVILIAN EMS: 0.2 – 4.4%
- Interfacility transport: 0.7 – 6.2%
- Primary transport from the scene: 4.9%
TRANSFUSION RATES OF TRAUMA PATIENTS IN CIVILIAN EMS: 3.0% – 3.5%
- Interfacility transport: 4.8% – 30%
- Primary transport from the scene: 1.6 % – 7.5%
TRANSFUSION RATES OF SEVERELY INJURED PATIENTS (“HIGHEST RISK POPULATION”) IN CIVILIAN EMS: 19% – 24%
TRANSFUSION RATES OF SEVERELY INJURED PATIENTS (“HIGHEST RISK POPULATION”) IN MILITARY SERVICES: 25% to 32%
Hemorrhage is often non-compressible and cannot be controlled by topical treatment, such as hemostatic dressings, tourniquets and/or pelvic binders. Moreover, patients may already be in hemorrhagic shock when pre-hospital healthcare providers arrive at a scene. Therefore, replacing (ongoing) blood loss as early as possible is important. Red blood cells (RBCs) provide effective volume expansion, restore oxygen-carrying capacity, and thereby potentially reducing acidosis through tissue hypoxia.
Read more about the current practice and the benefits of red blood cell transfusion here. https://onlinelibrary.wiley.com/doi/full/10.1111/tme.12667
Reference: Pre‐hospital transfusion of red blood cells. Part 1: A scoping review of current practice and transfusion triggers Elisabeth C. van Turenhout, Sebastiaan M. Bossers, Stephan A. Loer, Georgios F. Giannakopoulos, Lothar A. Schwarte, Patrick Schober