Prehospital blood transfusion: 5-year experience of an Australian helicopter emergency medical service

Introduction

There is an emerging body of evidence suggesting that early packed red blood cell transfusion accompanied by fresh frozen plasma, while limiting crystalloids, confers a survival benefit in major trauma [1]. Prehospital blood transfusion has been infrequently described, and concerns over expense, transfusion reactions, risk of disease transmission, short shelf half-life and difficult storage have limited the interest of prehospital providers.

Methods

All Greater Sydney Area HEMS (GSA-HEMS) prehospital missions involving a blood transfusion over a 66-month period were identified and reviewed. The prospectively completed GSA-HEMS electronic database was utilised to identify patients and extract data.

Results

We identified 158 missions involving a prehospital blood transfusion, of which 147 patient datasets were complete. The majority of patients had a blunt mechanism of injury (93.9%) and were male (69.3%) with a median (IQR) age of 34.5 (22 to 52) years (Table 1). The majority of patients were haemodynamically unstable, with a median (IQR) heart rate and systolic blood pressure of 115 (90 to 130) and 80 (65 to 105) mmHg, respectively. Twenty-two patients (15.0%) were pronounced life extinct on the scene. A total of 382 units of packed red blood cells were transfused, with a median of 3 units (range 1 to 6). No early transfusion reactions were noted. A variety of prehospital interventions accompanied the transfusions, ranging from rapid sequence intubation through to thoracotomies (Table 2).

Table 1 Demographics of patients receiving a prehospital blood transfusion

Table 2 Interventions performed

Conclusion

Despite the controversies over the role of fluids in the prehospital environment, the carriage and use of blood is both feasible and safe in a physician-led helicopter emergency medical service.