Prehospital administration of blood products: experiences from a Finnish physician-staffed helicopter emergency medical service

Joonas-Eemeli Kiili,Antti Kämäräinen,Pauli Vuorinen,Piritta Setälä,Sanna Hoppu

doi:10.1186/s12873-020-00350-x

Abstract

BackgroundMassive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome. Military experience suggests avoiding crystalloids using early damage control resuscitation with blood components in out of hospital setting. Civilian emergency medical services have since followed this idea. We describe our red blood cell protocol in helicopter emergency medical services (HEMS) and initial experience with prehospital blood products from the first 3 years after implementation.MethodsWe performed an observational study of patients attended by the HEMS unit between 2015 and 2018 to whom packed red blood cells, freeze-dried plasma, or both were transfused. The Student’s two-sided T-test was used to compare vitals in prehospital phase with those at the hospital’s emergency department. A p-value < 0.05 was considered significant.ResultsAltogether, 62 patients received prehospital transfusions. Of those, 48 (77%) were trauma patients and most (n = 39, 81%) suffered blunt trauma. The transfusion began at a median of 33 (IQR 21–47) minutes before hospital arrival. Median systolic blood pressure showed an increase from 90 mmHg (IQR 75–111 mmHg) to 107 mmHg (IQR 80–124 mmHg; P < 0.026) during the prehospital phase. Four units of red blood cells were handled incorrectly when unused red blood cells were returned and required disposal during a three-year period. There were no reported adverse effects from prehospital transfusions.ConclusionWe treated two patients per month with prehospital blood products. A prehospital physician-staffed HEMS unit carrying blood products is a feasible and safe method to start transfusion roughly 30 min before arrival to the hospital.Trial registrationThe study was retrospectively registered by the Tampere University Hospital’s Medical Director (R19603) 5.11.2019.

Highlights

Massive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome
Their medical records were reviewed for units of blood products transfused, start time of prehospital transfusion, first vital signs measured by the paramedics, first vital signs at the emergency department, ward of admission after the emergency department, and whether the patient was discharged alive from the university hospital
The helicopter emergency medical services (HEMS) unit is dispatched on emergency medical services (EMS) missions concerning out-ofhospital cardiac arrests, imminent childbirth, acute poisoning, and, at the discretion of the prehospital physician on call, any other life-threatening emergency in the area

Summary

Introduction

Massive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome. We describe our red blood cell protocol in helicopter emergency medical services (HEMS) and initial experience with prehospital blood products from the first 3 years after implementation. During the 1970s, fluid resuscitation was begun using normal saline solution and gradually moved towards blood component therapy [2]. This followed the idea that organ perfusion is restored when hypovolemia is reversed. Studies published during the last 10 years have made it evident that haemostatic resuscitation of bleeding trauma patients with early deployment of blood components is state of the art [5,6,7,8,9]

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Discussion

Conclusion