Abstract
Objective
Hemodynamic instability and hemorrhagic shock are frequently encountered by emergency
medical services providers managing ill and injured patients during critical care
transport. Although many critical care transport services commonly transfuse crystalloids
and/or packed red blood cells (PRBCs), the administration of whole blood (WB) in prehospital
care is currently limited. WB contains PRBCs, plasma, and platelets in a physiologic
ratio to aid in oxygen delivery to tissue as well as hemostasis. This study describes
a single critical care transport program's experience using WB for critically ill
and injured patients and reports important clinical and safety outcomes.
Methods
This study was a retrospective review of patients who were transported by a single
rotor wing–based critical care transport service to 1 of 2 tertiary care receiving
hospitals within a single health system. Patients who were transported between November
1, 2018, and November 30, 2019, and who received at least 1 unit of low-titer group
O WB during critical care transport were included. The primary outcomes of interest
included 24-hour mortality and the total 24-hour transfusion requirement. The safety
outcomes included transfusion reactions, acute lung injury, acute kidney injury, and
the incidence of venous thromboembolism.
Results
During the study period, there were 3,084 total patients transported by our critical
care transport service. There were 71 patients who received prehospital WB, 64 of
whom met the inclusion criteria. The top 3 indications for WB administration included
blunt trauma (n = 27, 42.2%), gastrointestinal hemorrhage (n = 15, 23.4%), and penetrating
trauma (n = 11, 17.2%). The median total number of blood components transfused within
24 hours was 4.0 (interquartile range, 2.0-9.5), and the overall 24-hour mortality
rate was 21.9%.
Conclusions
The administration of WB by emergency medical services providers to critically ill
and injured patients in the prehospital setting is feasible and is associated with
low incidences of adverse events and transfusion reactions. Further research is needed
to elucidate the benefits of WB relative to current prehospital standards of care.
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Article info
Publication history
Published online: June 17, 2022
Identification
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