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Effect of Pre-Hospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients

Rehn, Marius*,†,‡; Weaver, Anne*,§; Brohi, Karim§,||; Eshelby, Sarah*; Green, Laura§,||,¶; Røislien, Jo†,‡; Lockey, David J.*,‡,§,||

doi: 10.1097/SHK.0000000000001166
Clinical Aspects: PDF Only

Background: Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality.

Methods: Retrospective trauma database study comparing mortality before-implementation with after-implementation of phRTx in exsanguinating trauma patients. Univariate logistic regression was performed for the unadjusted association between phRTx and mortality was performed, and multiple logistic regression adjusting for potential confounders.

Results: We identified 623 subjects with suspected major haemorrhage. We excluded 84 (13.5%) patients due to missing data on survival status. Overall 187 (62.3%) patients died in the before phRTx period and 143 (59.8%) died in the after phRTx group. There was no significant improvement in overall survival after the introduction of phRTx (p = 0.554). Examination of pre-hospital mortality demonstrated 126 deaths in the pre-phRTx group (42.2%) and 66 deaths in the RBC administered group (27.6%) There was a significant reduction in pre-hospital mortality in the group who received RBC (p < 0.001).

Conclusions: phRTx was associated with increased survival to hospital, but not overall survival. The “delay death” effect of phRTx carries an impetus to further develop in-hospital strategies to improve survival in severely bleeding patients.

*London's Air Ambulance, Barts Health NHS Trust, London, UK

The Norwegian Air Ambulance Foundation, Drøbak, Norway

Faculty of Health Sciences, University of Stavanger, Stavanger, Norway

§Barts Health NHS Trust, London, UK

||Blizard Institute, Queen Mary, University of London, London, UK

NHS Blood and Transplant, London, UK

Address reprint requests to Marius Rehn, London's Air Ambulance, Royal London Hospital, Whitechapel Road, London E1 1BB, UK. E-mail:

Received 3 January, 2018

Revised 2 February, 2018

Accepted 11 April, 2018

Ethics approval and consent to participate: The project protocol was considered by the LAA research and development committee. It met local criteria for, and was registered as, a trust service evaluation project (ID 6191). No additional interventions were carried out and the study recorded only the frequency of events in normal practice with a view to service improvement. Ethical approval was therefore not sought. Consent for publication of individual person's data not applicable.

Authors contributions: All authors designed the study, collecting data and contributed in writing the manuscript; MR, SE and JR analysed the data. All authors read and approved the final manuscript.

Competing interests: The authors have no competing interests

Funding: The Norwegian Air Ambulance Foundation funded MR and JR expenses and publishing costs, but had no role in manuscript writing, study design, collection, analysis, or interpretation of data.

Availability of data and materials: The dataset used during the current study is available from the corresponding author on reasonable request.

© 2019 by the Shock Society