UMEM Educational Pearls

Title: Give the Patients What they Bleed, When they Bleed, and Where the Bleed it: EMS and Whole Blood

Keywords: trauma, EMS, hemorrhagic shock (PubMed Search)

Posted: 5/3/2024 by Ben Lawner, MS, DO
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BACKGROUND:
Prehospital administration of whole blood involves some areas of controversy. Though theoretical benefits are clear, concerns about logistics and timing of blood often dominates the discussion. This study was a retrospective analysis of prehospital blood administration within an urban EMS system from 2021-2023. Primary endpoints included: time to administration and in hospital mortality.

PATIENTS/METHODS:
The study population included patients presenting to the EMS system with signs and symptoms of hemorrhagic shock (SBP<70 or SBP<90 + HR> 100, n=61) and who received at least 1 unit of prehospital blood (PHB). The EMS system administered blood in conjunction with an advanced resuscitative bundle (calcium, TXA, blood). Isolated head injuries and blunt trauma patients were excluded from the analysis. The control group (n=82) was comprised of patients in the system's trauma registry presenting to EMS PRIOR to the initiation of whole blood and who exhibited similar clinical crtieria.

RESULTS:

PHB patients had significantly higher BP upon arrival to hospital
Following multivariate regression analysis, each minute delay to blood administration was linked to an independent increase in mortality of 11%
PHB group demonstrated lower in hospital mortality
PHB group linked to longer prehospital time interval (increased scene times)

BOTTOM LINE:
In this prospective study conducted within an urban EMS system, patients receiving prehospital whole blood demonstrated improved vital signs and reduced mortality when compared to a control group. Slightly extended prehospital time intervals for patients receiving PHB may be offset by the measured benefits of whole blood therapy.

References

Duchesne, J. , McLafferty, B. , Broome, J. , Caputo, S. , Ritondale, J. , Tatum, D. , Taghavi, S. , Jackson-Weaver, O. , Tran, S. , McGrew, P. , Harrell, K. , Smith, A. , Nichols, E. , Dransfield, T. , Marino, M. & Piehl, M. (9900). Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care. Journal of Trauma and Acute Care Surgery, Publish Ahead of Print , doi: 10.1097/TA.0000000000004363.