Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis

• Published in: Injury Vol. 50; no. 5; pp. 1017 - 1027
• Main Authors: Rijnhout, Tim W.H., Wever, Kimberley E., Marinus, Roy H.A.R., Hoogerwerf, Nico, Geeraedts, Leo M.G, Tan, Edward C.T.H.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-05-2019
• Subjects: Blood components; Blood Transfusion - mortality; Emergency Medical Services - methods; Hemorrhage - mortality; Hemorrhage - therapy; Humans; Prehospital; Survival Analysis; Time-to-Treatment; Transfusion; Trauma; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Blood components; Transfusion; Trauma; Prehospital
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.03.033

•An in-hospital survival benefit for trauma patients receiving prehospital blood components is still unclear.•Prehospital blood transfusion is safe.•High quality evidence is lacking.•Only two recently published randomised controlled trials are available.
Life-threatening haemorrhage accounts for 40% mortality in trauma patients worldwide. After bleeding control is achieved, circulating volume must be restored. Early in-hospital transfusion of blood components is already proven effective, but the scientific proof for the effectiveness of prehospital blood-component transfusion (PHBT) in trauma patients is still unclear.
To systematically review the evidence for effectiveness and safety of PHBT to haemorrhagic trauma patients.
CINAHL, Cochrane, EMBASE, and Pubmed were searched in the period from 1988 until August 1, 2018. Meta-analysis was performed for matched trauma patients receiving PHBT with the primary outcomes 24-hour mortality and long-term mortality. Secondary outcome measure was adverse events as a result of PHBT.
Trauma patients who received PHBT with simultaneous use of packed red blood cells (pRBCs) and plasma showed a statistically significant reduction in long-term mortality (OR = 0.51; 95% CI, 0.36–0.71; P < 0.0001) but no difference in 24-hour mortality (OR = 0.47, 95% CI, 0.17–1.34; P = 0.16). PHBT with individual use of pRBCs showed no difference in long-term mortality (OR = 1.18; 95% CI, 0.93–1.49; P =  0.17) or 24-hour mortality (OR = 0.92; 95% CI, 0.46–1.85; P =  0.82). In a total of 1341 patients who received PHBT, 14 adverse events were reported 1.04%, 95% CI 0.57–1.75%.
PHBT with simultaneous use of both pRBCs and plasma resulted in a significant reduction in the odds for long-term mortality. However, based on mainly poor quality evidence no hard conclusion can be drawn about a possible survival benefit for haemorrhagic trauma patients receiving PHBT. Overall, PHBT is safe but results of currently ongoing randomised controlled trials have to be awaited to demonstrate a survival benefit.
Systematic review and meta-analysis