Over the last decade, significant research has emerged, highlighting the importance of fast prehospital intervention in acute trauma settings.

As evidenced by the following studies—early access to, and transfusion of packed red blood cells (pRBC) and blood products have a direct correlation to improved outcomes for trauma patients. 

Portable blood and IV fluid warmers, such as the ˚M Warmer System, play a vital role in bridging the gap between prehospital care and the Emergency Department (ED) encounter.  

The Contemporary Timing of Trauma Deaths

Over the last decade, there have been continued improvements in trauma and intensive care unit (ICU) care, related to damage control techniques and evidence-based ICU pathways. 

A study published in 2018 in The Journal of Trauma and Acute Care Surgery, aimed to evaluate the contemporary distribution of trauma deaths after the widespread implementation of modern trauma and critical care principles.

4,185,009 patients were analyzed and thirty-four percent of all deaths occurred within the first 24 hours of admission. The factors most associated with death in the first 24 hours were severe abdominal trauma (73%), penetrating trauma (55%), and severe extremity trauma (58%). The distribution of deaths was seen to fall rapidly after the first 24 hours and continued to be flat for 30 days in all subgroups analyzed. 

Early deaths, however, remain a significant challenge, specifically from non-compressible abdominal hemorrhage and extremity trauma. Primary prevention and early hemorrhage control must continue to be a focus of research and trauma systems.

Prehospital blood product transfusion improves acute and 30-day survival

A retrospective cohort study by Shackelford et. al., conducted in 2017 was the first to establish a clear link between prehospital transfusion and improved survival rates within 24 hours—and after 30 days—post-incident. Notably, the study concluded that administering transfusions within 30 minutes of injury had a remarkable, fourfold increase in the chance for prolonged survival. This significant finding underscores the critical role of prehospital blood transfusion in the race towards zero preventable deaths after injury. 

Even though it is intuitive that early transfusion for hemorrhagic shock should improve survival, there was no data that could demonstrate a survival advantage, prior to this publication. Therefore, Stacy A. Shackelford and her co-authors’ groundbreaking research provides valuable insight into the correlation between prehospital blood product transfusion and improved patient outcomes.

Of 502 combat casualties, 3 of 55 prehospital transfusion recipients (5%) and 85 of 447 nonrecipients (19%) died within 24 hours of MEDEVAC rescue. By day 30, 6 recipients (11%) and 102 nonrecipients (23%) died. Another important finding was that time to initial transfusion, regardless of location (prehospital or during hospitalization), was associated with reduced 24-hour mortality only up to 15 minutes after MEDEVAC rescue, which again emphasizes how important fast intervention is when treating hemorrhagic shock.

Shorter times to packed red blood cell (pRBC) associated with decreased mortality in trauma patients

Hemorrhage is a leading cause of death in traumatically injured patients. A study by Powell et al. evaluated the association of earlier pRBC (packed red blood cell) administration and mortality when compared with later transfusion initiation.

This study of trauma patients transported by a single helicopter service from the scene of injury to an urban trauma center included patients receiving at least one unit of pRBC within 24 hours of hospital arrival.

They found out that delays in time to pRBC administration of as short as 10 minutes were associated with increased odds of death for patients receiving ultra-early pRBC transfusion. Expedient prehospital and ED transfusion capabilities may improve outcomes after trauma.

As we continue to fight against hypothermia and delayed prehospital access to pRBC and blood products in acute trauma settings, let the ˚M Warmer System be the key catalyst for positive patient outcomes.



The ˚M Warmer System

The ˚M Warmer is a portable blood and IV fluid warming device optimal for both prehospital and hospital use as it is small, simple to use and has extremely efficient warming capabilities (150 ml/min).