Pre-hospital blood transfusion \u2013 an ESA survey of European practice

Benoît Vivien,Jochen Hinkelbein,Luca Brazzi,Kurt Rützler,Damian Keene,Karl-Christian Thies,Anatolij Truhlář

doi:10.1186/s13049-020-00774-1

Abstract

BackgroundBlood products are a lifesaving commodity in the treatment of major trauma.Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage.The primary aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The secondary aim was to evaluate opinions about PHBP and also the experience and the personal views of its users.MethodsThe subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d’Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries.ResultsIn total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37 and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%.Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently.ConclusionsWe found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.

Highlights

Blood products are a lifesaving commodity in the treatment of major trauma
The European guidelines on management of major bleeding and coagulopathy following major trauma [1] suggests that bleeding trauma patients should be rapidly transported to major trauma centres to institute appropriate treatment as soon as possible
In an attempt to reduce morbidity and mortality, prehospital transfusion of blood products has been initiated in several trauma settings throughout Europe

Summary

Introduction

Blood products are a lifesaving commodity in the treatment of major trauma. There is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage. The primary aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. Massive haemorrhage is the main cause of preventable death in trauma. The key components of treatment are immediate haemorrhage control and transfusion of blood products to replace volume and manage coagulopathy. In an attempt to reduce morbidity and mortality, prehospital transfusion of blood products has been initiated in several trauma settings throughout Europe. The benefits are discussed controversially, especially as scientific evidence remains ambiguous

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