Abstract 324: Effect of Prehospital Use of Plasma and Erythrocytes on Crystalloid and Blood Product Requirements in Trauma

Abstract

Introduction: Recent studies demonstrated positive effects of blood products (BP) administration by helicopter emergency medical services (HEMS) to trauma patients but most of them were limited to specific cohorts (e.g. mixture of primary and secondary transports, long prehospital times, high prevalence of penetrating injuries, military use). This study aimed to assess implementation of prehospital use of BP into a regional trauma system treating predominantly blunt injuries (>95 %) and achieving short prehospital times (first emergency call to handover at trauma center ~60 min). Methods: A prospective observational study in patients treated with prehospital plasma (1 unit) followed by erythrocytes (1 unit) during the initial 7 months of the RABBIT trial (Rapid Administration of Blood by HEMS in Trauma, ClinicalTrials NCT03522636). The treatment group was compared to a historical cohort treated with massive transfusion protocol but no BP available prehospitally. It was hypothesized that early transfusion was associated with lower severity of coagulopathy and lower requirements for crystalloids and BP within 24 hours. Data analysis was performed using Prism 6.0 (GraphPad, La Jolla, USA). Results: Twenty patients treated with prehospital BP (Jun-Dec 2018) were compared to 24 patients in a control group (Jun-Dec 2017). There were no secondary transports. No differences were found between groups in age (47.0 ± 4.1 vs. 46.1 ± 3.7 years, p=0.87), ISS (33.5 ± 3.7 vs. 35.8 ± 3.4, p=0.65), prehospital time (60.9 ± 3.8 vs. 63.8 ± 3.6 min, p=0.59), fibrinogen (2.6 ± 0.2 vs. 2.5 ± 0.2 g/L, p=0.74) and lactate on admission to trauma center (4.5 ± 0.7 vs. 4.4 ± 0.7 mmol/L, p=0.94). The treated patients had better INR (1.1 ± 0.1 vs. 1.4 ± 0.1, p=0.028), and required 14.5 ± 1.7 units of BP in 24 hours compared to 21.42 ± 4.0 units in a control group (p=0,15). Prehospital and emergency department (ED) dose of crystalloids was reduced from 1696 ± 161 mL to 1088 ± 137 mL (p=0.006). No colloids were given at any time. There were no transfusion related complications. Conclusion: Prehospital use of plasma and erythrocytes in a setting with short prehospital times was associated with lower need for crystalloids, better INR at admission, and a trend towards lower consumption of BP in a trauma center.