Highlights
- •Prehospital prediction of massive transfusion reduces delays in resuscitation.
- •Many factors reported to predict a massive transfusion protocol (MTP) are not available during flight transport.
- •In this study, whole blood, systolic blood pressure, and Glasgow Coma Scale score accurately predicted MTP in trauma patients.
- •Three factors available during flight are of clinical utility in MTP prediction.
Abstract
Objective
Early identification of the subset of trauma patients with acute hemorrhage who require
resuscitation via massive transfusion protocol (MTP) initiation is vital because such
identification can ensure the availability of resuscitation products immediately upon
hospital arrival and result in improved clinical outcomes, including reduced mortality.
However, there are currently few studies on the predictors of MTP in the unique setting
of flight transport.
Methods
This was a retrospective study of adult trauma patients transported from the scene
via flight to 6 trauma centers between March 1, 2019, and January 21, 2021. Patients
were included if they had emergency medical service vitals documented. The variables
collected included demographics, comorbidities, cause of injury, body regions injured,
in-flight treatments, and transport vitals. The primary outcome was MTP initiated
by the receiving hospital.
Results
A total of 212 patients were included, of whom 16 (8%) had MTP initiated. During flight
transport, 24 (11%) received whole blood, 9 (4%) received packed red blood cells,
11 (5%) had a tourniquet placed, and 5 (2%) received tranexamic acid. In adjusted
analyses, receiving whole blood during transport (odds ratio [OR] = 8.52, P < .01), systolic blood pressure ≤ 90 mm Hg (OR = 8.07, P < .01), and a Glasgow Coma Scale score < 13 (OR = 8.38, P < .01) were independently associated with MTP.
Conclusions
This retrospective cohort study showed that 3 factors readily available in the flight
setting—receipt of whole blood, systolic blood pressure, and Glasgow Coma Scale score—are
strong predictors of MTP at the receiving facility, particularly when considered in
aggregate.
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Article info
Publication history
Published online: December 22, 2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
