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Pre-Hospital Blood Transfusion: A Pro-Con Debate
In the clinical domain of trauma management, exsanguination is the leading mechanism of patient mortality. The prompt restoration of intravascular volume and oxygen carrying capacity with blood products is central to mitigating the risk of death and the clinical sequelae of hemorrhagic shock. In the military setting, blood products are often administered to trauma victims during transport given the unpredictability of transferring them to emergency care facilities in austere environments. This has prompted the question of whether immediate blood transfusion for trauma victims should be initiated prior to hospital arrival in the civilian sector. A pro-con debate in this issue of Anesthesia & Analgesia considers the merits and disadvantages of such an approach which are summarized in this infographic. Randomized controlled trials are often unrealistic in the trauma setting and as such, much of the literature addressing pre-hospital transfusion practice is retrospective, observational, underpowered, and of low sample size. Additionally, conclusions from military data can only be marginally extrapolated to the civilian demographic given the stark differences between the two groups. Nonetheless, important questions such as whether the practice observes higher rates of transfusion reactions or wastage of blood products have been explored. Based on available data, these concerns have not been compelling enough to create stop gaps in the practice of pre-hospital transfusion. What is underscored by the authors of this debate is that the timeliness of blood product administration is likely the most important factor in determining patient outcomes rather than the setting of transfusion. Consequently, pre-hospital transfusion may significantly benefit trauma patients when longer transit times to medical centers are expected. The reader is encouraged to review the cited articles for a full scope of understanding of these concepts.
1. Dudaryk R, et al. Pro-con debate: pre-hospital blood transfusion – should it be adopted for Civilian Trauma? Anesth Analg. 2022;134:678–682.
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2. Csete ME. Pre-hospital blood transfusion for severe trauma: translating experience from the military to the civilian setting is not always straightforward. Anesth Analg. 2022;134:675–677.