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Civilian prehospital transfusion – experiences from a French region
Author(s) -
Cassignol Arnaud,
Marmin Julien,
Mattei Pascal,
Goffinet Léa,
Pons Sandrine,
Renard Aurélien,
Demory Didier,
Bordes Julien
Publication year - 2020
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12984
Subject(s) - medicine , glasgow coma scale , fresh frozen plasma , resuscitation , emergency medicine , blood pressure , shock (circulatory) , blood transfusion , retrospective cohort study , medical record , intensive care medicine , surgery , platelet
Background and objectives Haemorrhagic shock is a leading cause of avoidable mortality in prehospital care. For several years, our centre has followed a procedure of transfusing two units of packed red blood cells outside the hospital. Our study’s aim was twofold: describe the patient characteristics of those receiving prehospital blood transfusions and analyse risk factors for the 7‐day mortality rate. Materials and methods We performed a monocentric retrospective observational study. Demographic and physiological data were recovered from medical records. The primary outcome was mortality at seven days for all causes. All patients receiving prehospital blood transfusions between 2013 and 2018 were included. Results Out of 116 eligible patients, 56 patients received transfusions. Trauma patients ( n = 18) were younger than medical patients ( n = 38) ( P = 0·012), had lower systolic blood pressure ( P = 0·001) and had higher haemoglobin levels ( P = 0·016). Mortality was higher in the trauma group than the medical group ( P = 0·015). In‐hospital trauma patients received more fresh‐frozen plasma and platelet concentrate than medical patients ( P < 0·05). Predictive factors of 7‐day mortality included transfusion for trauma‐related reasons, low Glasgow Coma Scale, low peripheral oxygen saturation, prehospital intensive resuscitation, existing coagulation disorders, acidosis and hyperlactataemia ( P < 0·05). Conclusion Current guidelines recommend early transfusion in patients with haemorrhagic shock. Prehospital blood transfusions are safe. Coagulation disorders and acidosis remain a cause of premature death in patients with prehospital transfusions.