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Turnbull C, Clegg L, Santhakumar A, Micalos PS. Blood Product Administration in the Prehospital Setting: A Scoping Review. PREHOSP EMERG CARE 2024:1-14. [PMID: 39159401 DOI: 10.1080/10903127.2024.2386007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVES Implementing prehospital blood products for treating hemorrhagic shock has been utilized globally in military and civilian settings. This review aims to compare various guidelines for using blood products, including the types of blood products, injuries, biomarkers (hemodynamic measurement) to indicate use, associated treatments and risks, and the logistical concerns of storage and wastage in the prehospital setting. Furthermore, it explores whether prehospital blood transfusions are beneficial and a safe treatment option. METHODS Data were collected using a systematic search and screening process of online databases CINAHL, Medline, and Scopus, as well as by creating a PRISMA flow diagram to screen articles using inclusion and exclusion criteria. Forty-five articles were screened, with twenty-five excluded, resulting in twenty articles in this scoping review. RESULTS The most frequently used blood product used was red blood cells, with twelve studies using either red blood cells alone or in combination with other products. Indications for blood use varied across services, but all aimed to address hemodynamic instability as a primary indication for blood transfusion. Eleven studies recorded no adverse reactions. Only one study reported chills and shivers; however, it was unclear if blood products were the cause. Nine studies avoided logistical issues of storage and wastage to create a feasible rotation system. CONCLUSIONS Prehospital blood was used in medical, trauma, and maternity-related hemorrhage. Many types of blood products are in use, ranging from component therapy to whole blood, with each protocol having different indications of use and treatment guidelines aimed at improving hemodynamic stability.
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Affiliation(s)
- Caitlin Turnbull
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Lisa Clegg
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Abishek Santhakumar
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Peter S Micalos
- School of Dentistry and Medical Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
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Asirvatham V, Gupta A, Bava D, Tripathi PP, Mittal S. Challenges in organising blood donation camps at remote military base and its impact on blood component quality: A unique helicopter-based whole blood transport experience. Transfus Apher Sci 2024; 63:103955. [PMID: 38838567 DOI: 10.1016/j.transci.2024.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND There is a huge gap between safe blood supply and clinical demand in India and voluntary blood donation camps (BDSs) are vital to address this gap. The study evaluates the challenges faced in organizing remote setting voluntary BDCs and assess the impact of helicopter-flight on the quality of the whole blood units (WBU) and blood components (BC) prepared. METHODS This is an observational study in which two voluntary BDCs were organised in remote military-based setting in 2021. Pre-camp activities, camp organisation, community engagement, and transportation logistics were evaluated. All WBU collected were exposed to helicopter-flight for transportation to the main blood centre with cold-chain maintenance. Impact of helicopter-flight on WBU and BC prepared was evaluated by performing extensive quality control (QC) testing. RESULTS A total of 123 WBU were collected in both camps with transportation time of 160 and 150 min for camp-1 and -2 respectively. 123 PRBC, 22 BC-PC, 75 FFP and 48 CRYO units were prepared in-total within recommended time-limits. No haemolysis was detected in WBU, and all BC met QC criteria as per National guidelines. CONCLUSIONS Proper pre-camp planning, prior screening of donors, clear collection process policy, feasibility of efficient transport system, regular communication, and maintenance of cold-chain are crucial factors in determining the success of remote BDCs and quality of BC. Our study provides practical recommendations for policymakers, military healthcare providers, transfusion medicine specialists and public health professionals to enhance the effectiveness and sustainability of voluntary blood donation programs in remote settings.
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Affiliation(s)
- Vasanth Asirvatham
- Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Anubhav Gupta
- Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Davood Bava
- Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Parmatma Prasad Tripathi
- Department of Transfusion Medicine and Hematology. National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Siddharth Mittal
- Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
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Callaghan NI, Quinn J, Liwski R, Chisholm N, Cheng C. Process Mining Uncovers Actionable Patterns of Red Blood Cell Unit Wastage in a Health Care Network. Transfus Med Rev 2024; 38:150827. [PMID: 38642414 DOI: 10.1016/j.tmrv.2024.150827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024]
Abstract
Packed red blood cell transfusions are integral to the care of the critically and chronically ill patient, but require careful storage and a large, coordinated network to ensure their integrity during distribution and administration. Auditing a Transfusion Medicine service can be challenging due to the complexity of this network. Process mining is an analytical technique that allows for the identification of high-efficiency pathways through a network, as well as areas of challenge for targeted innovation. Here, we detail a case study of an efficiency audit of the Transfusion Medicine service of the Nova Scotia Health Administration Central Zone using process mining, across a period encompassing years prior to, during, and after the acute COVID-19 pandemic. Service efficiency from a product wastage perspective was consistently demonstrated at benchmarks near globally published optima. Furthermore, we detail key areas of continued challenge in product wastage, and suggest potential strategies for further targeted optimization.
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Affiliation(s)
- Neal I Callaghan
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason Quinn
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada
| | - Robert Liwski
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada
| | - Natalie Chisholm
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada
| | - Calvino Cheng
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada.
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Jama T, Lefering R, Lauronen J, Handolin L. Factors affecting physicians' decision to start prehospital blood product transfusion in blunt trauma patients: A cohort study of Helsinki Trauma Registry. Transfusion 2024; 64 Suppl 2:S167-S173. [PMID: 38511866 DOI: 10.1111/trf.17791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Prehospital blood transfusions are increasing as a treatment for bleeding trauma patients at risk for exsanguination. Triggers for starting transfusion in the field are less studied. We analyzed the factors affecting the decision of physicians to start prehospital blood product transfusion (PHBT) in blunt adult trauma patients. STUDY DESIGN AND METHODS Data of all adult blunt trauma patients from the Helsinki Trauma Registry between March 2016 and July 2021 were retrospectively analyzed. Univariate analysis for the identification of predictive factors and multivariate regression analysis for their importance as predictive factors for the initiation of PHBT were applied. RESULTS There were 1652 patients registered in the database. A total of 556 of them were treated by a physician-level prehospital emergency care unit, of which by transfusion-capable unit in 394 patients. PHBT (red blood cells and/or plasma) was started in 19.8% of the patients. We identified three statistically highly important clinical triggers for starting PHBT: high crystalloid volume need, shock index ≥0.9, and need for prehospital pleural decompression. DISCUSSION PHBT in blunt adult trauma patients is initiated in ~20% of the patients in Southern Finland. High crystalloid volume need, shock index ≥0.9 and prehospital pleural decompression are associated with the initiation of PHBT, probably reflecting patients at high risk for bleeding.
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Affiliation(s)
- Timo Jama
- Wellbeing Services County of Päijät-Häme, Lahti, Finland
- University of Helsinki, Helsinki, Finland
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Jouni Lauronen
- University of Helsinki, Helsinki, Finland
- Finnish Red Cross Blood Service, Vantaa, Finland
| | - Lauri Handolin
- University of Helsinki, Helsinki, Finland
- Helsinki University Hospital Trauma Unit, Helsinki, Finland
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Susila S, Ilmakunnas M, Lauronen J, Vuorinen P, Ångerman S, Sainio S. Low titer group O whole blood and risk of RhD alloimmunization: Rationale for use in Finland. Transfusion 2024; 64 Suppl 2:S119-S125. [PMID: 38240146 DOI: 10.1111/trf.17700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Prehospital low-titer group O whole blood (LTOWB) used for patients with life-threatening hemorrhage is often RhD positive. The most important complication following RhD alloimmunization is hemolytic disease of the fetus and newborn (HDFN). Preceding clinical use of RhD positive LTOWB, we estimated the risk of HDFN due to LTOWB prehospital transfusion in the Finnish population. STUDY DESIGN AND METHODS We collected data on prehospital transfusions in Tampere and Helsinki University Hospital areas. Using the mean of reported alloimmunization rates in trauma studies (24%) and a higher reported rate representing trauma patients of 13-50 years old (42.7%), we estimated the risk of HDFN and extrapolated it to the whole of Finland. RESULTS We estimated that in Finland, with the current prehospital transfusion rate we would see 1-3 cases of severe HDFN due to prehospital LTOWB transfusions every 10 years, and fetal death due to HDFN caused by LTOWB transfusion less than once in 100 years. DISCUSSION The estimated risk of serious HDFN due to prehospital LTOWB transfusion in the Finnish population is similar to previous estimates. As Finland routinely screens expectant mothers for red blood cell antibodies and as the contemporary treatment of HDFN is very effective, we support the prehospital use of RhD positive LTOWB in all patient groups.
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Affiliation(s)
- Sanna Susila
- Finnish Red Cross Blood Service, Vantaa, Finland
- Emergency Medical Service and Emergency Department, Päijät-Häme wellbeing services county, Lahti, Finland
| | - Minna Ilmakunnas
- Finnish Red Cross Blood Service, Vantaa, Finland
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Meilahti Hospital Blood Bank, Department of Clinical Chemistry, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Pauli Vuorinen
- Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa wellbeing services county, Tampere, Finland
| | - Susanne Ångerman
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Spies F, Burmester A, Schälte G. [The correct way to deal with the definitive surgical airway]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01280-6. [PMID: 37266737 DOI: 10.1007/s00101-023-01280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 06/03/2023]
Abstract
Dealing with a difficult airway is familiar to emergency care providers in both the prehospital and clinical settings. In anesthesiology and emergency medical care different algorithms almost equal in their wording have been introduced, indicating that an emergency front of neck airway access (eFONA) has to be established in the case of a cannot ventilate-cannot oxygenate situation. In a survey (Surveymonkey®) data concerning the level of experience with eFONA, devices required, previous training and complications were allocated among acute and emergency care providers of different backgrounds (doctors and paramedics). Furthermore, we asked about individual attitudes to and frequency of previous situations, in which an eFONA was not established despite strong indications. Of the respondents 15% (n = 63) answered that they had experienced this type of situation. eFONA had been performed by 28% of the interviewed (n = 117), reflecting the high number of military and EMT (emergency medical team) physicians participating in the survey. The number of experiences are rarely representative for the civilian setting. Different adjuncts may be helpful to detect the cricothyroid ligament. To use ultrasound seems obvious but it doubles the time for the detection of the cricothyroid ligament. Laryngeal masks can be employed as a supraglottic airway device (SAD) during "plan B". Stabilizing the airway with a SAD almost doubles the success of identifying laryngeal landmarks in females. The crew resource management (CRM) guidelines are more than essential in threatening situations demanding measures like eFONA. Providers should anticipate emerging problems and whenever feasible call for help and finally speak up. Naming a failed airway should be avoided as it implies a failure of the provider or of the entire airway team. In fact, the term non-accessible airway should be introduced. This might help to avoid the implication of a major failure. So far, an ideal simulator to train eFONA has not been introduced but it is mandatory to train procedures and algorithms on different types of simulators and manikins to achieve mastery.
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Affiliation(s)
- Fabian Spies
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Alexander Burmester
- Klinik für Anästhesie und Intensivmedizin, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Deutschland
| | - Gereon Schälte
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Xia J, Li Q, Tian Y, Zhao Y, Shen Z, Zhou T, Li J. An unmanned emergency blood dispatch system based on an early prediction and fast delivery strategy: Design and development study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 235:107512. [PMID: 37030176 DOI: 10.1016/j.cmpb.2023.107512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/10/2023] [Accepted: 03/25/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND AND OBJECTIVE For severe trauma patients, hemorrhage is the most common cause of medically preventable deaths. Early transfusion is beneficial to major hemorrhagic patients. However, the early supply of emergency blood products for major hemorrhagic patients is still a major problem in many areas. The aim of this study was to design and develop an unmanned emergency blood dispatch system for the fast delivery of blood resources and rapid emergency response to trauma events, especially those with mass hemorrhagic trauma patients and those occurred in remote areas. METHODS Based on the process of emergency medical services for trauma patients, we introduced unmanned aerial vehicle (UAV) and designed the main flowchart of the dispatch system, which combines an emergency transfusion prediction model and UAV-related dispatch algorithms to improve first aid efficiency and quality. The system identifies patients in need of emergency transfusion through a multidimensional prediction model. Then, by analyzing the blood center, hospitals and UAV stations nearby, the system recommends the patient's transfer destination for emergency transfusion and dispatch schemes of UAVs and trucks for a fast supply of blood products. Simulation experiments of urban and rural scenarios were conducted to evaluate the proposed system. RESULTS The developed emergency transfusion prediction model of the proposed system achieves a higher AUROC value of 0.8453 than a classical transfusion prediction score. In the urban experiment, by adopting the proposed system, the average wait time per patient decreased from 32 to 18 min, and the total time decreased from 42 to 29 min. Owing to the combination of the prediction and the fast delivery function, the proposed system took 4 and 11 min less wait time than the strategy with only the prediction function and the strategy with only the fast delivery function, respectively. In the rural experiment, for trauma patients requiring an emergency transfusion at 4 locations, the wait time for transfusion under the proposed system was 16.54, 17.08, 38.70 and 46.00 min less than that under the conventional strategy. The health status-related score increased by 6.9%, 0.9%, 19.1% and 36.7%, respectively. CONCLUSIONS Experimental results demonstrate that the proposed system works well with a faster blood supply speed for severe hemorrhagic patients and better health status. With the assistance of the system, emergency doctors at the scene of an injury are able to comprehensively analyze patients' status and the surrounding rescue conditions and then make decisions, especially when encountering mass casualties or casualties in remote areas.
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Affiliation(s)
- Jing Xia
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China
| | - Qiang Li
- Emergency Department, the Second Affiliated Hospital, Zhejiang University School of Medicine and Institute of Emergency Medicine, Zhejiang University, Hangzhou, China
| | - Yu Tian
- Engineering Research Center of EMR and Intelligent Expert System, Key Laboratory for Biomedical Engineering of Ministry of Education, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yinghao Zhao
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China
| | - Zhuyi Shen
- Engineering Research Center of EMR and Intelligent Expert System, Key Laboratory for Biomedical Engineering of Ministry of Education, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Tianshu Zhou
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China
| | - Jingsong Li
- Research Center for Healthcare Data Science, Zhejiang Laboratory, Hangzhou, China; Engineering Research Center of EMR and Intelligent Expert System, Key Laboratory for Biomedical Engineering of Ministry of Education, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
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Johnson B, Bucio J, Salerno C, Jeevanandam V, Song T, Wool G. Decreasing blood wastage during ex vivo lung perfusion recovery through utilization of thermal control technology. J Card Surg 2022; 37:5011-5018. [PMID: 36349705 PMCID: PMC10099649 DOI: 10.1111/jocs.17147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Organ Care System (OCS) is a revolutionary ex vivo organ perfusion technology that can potentially expand the organ retrieval range. The OCS Lung device uses packed red blood cells (pRBC) with a proprietary solution. We report the ability to reduce blood waste during this procedure by using a thermal packaging solution in conjunction with the OCS platform. METHODS We retrospectively reviewed all OCS Lung recoveries performed by our recovery team, using pRBCfrom May 2019 to January 2021. Initially, units were stored using passive refrigeration with the Performance cooler at a temperature range of 1-6°C for 4 h. Subsequently, thermal control technology with the ProMed cooler was utilized to maintain the same temperature range for 72 h. RESULTS Twenty-three recoveries were initiated with 63 pRBC. The Performance cooler was used for 8, while the ProMed cooler for 13. 37.5% of pRBC transported with the Performance cooler was used within the validated time range, while 25.0% were used beyond the validated time range based on clinical judgment. In addition, 37.5% of pRBC transported with the Performance cooler were returned to the institution after canceled recoveries with an estimated loss of $1800; the ProMed cooler had no wastage. CONCLUSIONS This study showed that using an advanced thermal packaging solution facilitates proper storage of pRBC and represents an advancement for extended donor lung preservation. The elimination of blood wastage in this initial study portends ongoing benefits for the limited blood supply and reduced cost.
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Affiliation(s)
- Blaine Johnson
- Perfusion Services, UChicago Medicine, Chicago, Illinois, USA
| | - Jamie Bucio
- Department of Surgery, Section of Cardiac Surgery, University of Chicago, Chicago, Illinois, USA
| | - Christopher Salerno
- Department of Surgery, Section of Cardiac Surgery, University of Chicago, Chicago, Illinois, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac Surgery, University of Chicago, Chicago, Illinois, USA
| | - Tae Song
- Department of Surgery, Section of Cardiac Surgery, University of Chicago, Chicago, Illinois, USA
| | - Geoffrey Wool
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
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Broome JM, Ali A, Simpson JT, Tran S, Tatum D, Taghavi S, DuBose J, Duchesne J. IMPACT OF TIME TO EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION AFTER NONCOMPRESSIBLE TORSO HEMORRHAGE. Shock 2022; 58:275-279. [PMID: 36256624 DOI: 10.1097/shk.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Introduction: Time is an essential element in outcomes of trauma patients. The relationship of time to treatment in management of noncompressible torso hemorrhage (NCTH) with resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) has not been previously described. We hypothesized that shorter times to intervention would reduce mortality. Methods: A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry from 2013 to 2022 was performed to identify patients who underwent emergency department aortic occlusion (AO). Multivariate logistic regression was used to examine the impact of time to treatment on mortality. Results: A total of 1,853 patients (1,245 [67%] RT, 608 [33%] REBOA) were included. Most patients were male (82%) with a median age of 34 years (interquartile range, 30). Median time from injury to admission and admission to successful AO were 31 versus 11 minutes, respectively. Patients who died had shorter median times from injury to successful AO (44 vs. 72 minutes, P < 0.001) and admission to successful AO (10 vs. 22 minutes, P < 0.001). Multivariate logistic regression demonstrated that receiving RT was the strongest predictor of mortality (odds ratio [OR], 6.6; 95% confidence interval [CI], 4.4-9.9; P < 0.001). Time from injury to admission and admission to successful AO were not significant. This finding was consistent in subgroup analysis of RT-only and REBOA-only populations. Conclusions: Despite expedited interventions, time to aortic occlusion did not significantly impact mortality. This may suggest that rapid in-hospital intervention was often insufficient to compensate for severe exsanguination and hypovolemia that had already occurred before emergency department presentation. Selective prehospital advanced resuscitative care closer to the point of injury with "scoop and control" efforts including hemostatic resuscitation warrants special consideration.
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Affiliation(s)
- Jacob M Broome
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ayman Ali
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - John T Simpson
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sherman Tran
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Danielle Tatum
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sharven Taghavi
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Joseph DuBose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Juan Duchesne
- Division of Trauma and Critical Care, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Initial experiences of prehospital blood product transfusions between 2016 and 2020 in Päijät-Häme hospital district, Finland. Scand J Trauma Resusc Emerg Med 2022; 30:39. [PMID: 35668435 PMCID: PMC9169387 DOI: 10.1186/s13049-022-01027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Treating hemorrhaging patients with prehospital blood product transfusions (PHBT) narrows transfusion delays and potentially benefits the patient. We describe our initial experiences of PHBT in a ground-based emergency medical service (EMS), where the transfusion protocol covers both traumatic and nontraumatic hemorrhaging patients. Methods A descriptive retrospective analysis was performed on the records of all the patients receiving red blood cells, freeze-dried plasma, or both during prehospital care from September 2016 to December 2020. The delays of PHBT and the effects on patients’ vital signs were analyzed and reported as the median and interquartile range (IQR) and analyzed using a Wilcoxon Signed rank test. Results 65 patients received prehospital blood product transfusions (PHBT), 29 (45%) were non-traumatic, and 36 (55%) traumatic. The main two reasons for PHBT were blunt trauma (n = 30, 46%) and gastrointestinal hemorrhage (n = 20, 31%). The median time from the emergency call to the start of PHBT was 54 min (IQR 38), and the transfusion began on a median of 61 min (IQR 42) before arrival at the hospital. The median systolic blood pressure improved from a median 76.5 mmHg (IQR 36.5) before transfusion to a median of 116.60 mmHg (IQR 26.5) (p < 0.001) on arrival to the hospital. No transfusion-related severe adverse events were noted. Conclusions Starting PHBT in ground-based EMS is a feasible and viable option. The PHBT began significantly earlier than it would have started on arrival to the hospital, and it seems to be safe and improve patients’ physiology. Study approval D/2603/07.01.04.05/2019.
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Csete M. Prehospital Blood Transfusion for Severe Trauma: Translating Experience From the Military to the Civilian Setting Is Not Always Straightforward. Anesth Analg 2022; 134:675-677. [PMID: 35299207 DOI: 10.1213/ane.0000000000005780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Marie Csete
- From the ConeSight Therapeutics, c/o Pasadena Bio Collaborative Incubator, Pasadena, California.,Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California
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12
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Weather and Prehospital Predictors of Trauma Patient Mortality in a Rural American State. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
More than 1,000,000 units of lyophilized plasma have been used in France, Germany, and South Africa. Recently, numerous other countries have adopted lyophilized plasma for patients with severe bleeding in prehospital and austere settings.
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Greene A, Vu EN, Archer T, Norman S, Trojanowski J, Shih AW. A Service Evaluation of Prehospital Blood Transfusion by Critical Care Paramedics in British Columbia, Canada. Air Med J 2021; 40:441-445. [PMID: 34794786 DOI: 10.1016/j.amj.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022]
Abstract
Early administration of blood products is emerging as best practice in selected trauma and medical patients. Blood products carried by critical care transport (CCT) teams are sometimes the first available to critically ill and injured patients. The purpose of this research was to evaluate the introduction of prehospital transfusion into a paramedic-led CCT program in Canada. A retrospective review of electronic patient care records for all patients who received a prehospital transfusion of uncrossmatched group O packed red blood cells between February 10, 2019, and September 30, 2020, was conducted. Forty-eight patients received a prehospital transfusion. The median age of the patients was 44 years, 81.3% were male, and most patients were victims of blunt trauma. Packed red blood cells were associated with a significant increase in systolic blood pressure (P < .001) and mean arterial pressure (P < .001), a decrease in shock index (P < .001), and a reduction in the time to first transfusion, with minimal waste, no patient-related adverse events, and complete traceability. The results of this service evaluation demonstrate the successful introduction of prehospital transfusion into a paramedic-led CCT program. Further prospective research is needed to assess the impact of such a protocol in this patient population.
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Affiliation(s)
- Adam Greene
- Critical Care Transport Program, British Columbia Emergency Health Services, Vancouver, British Columbia, Canada.
| | - Erik N Vu
- Critical Care Transport Program, British Columbia Emergency Health Services, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Archer
- Emergency Medical Retrieval and Transfer Service Cymru, Wales, United Kingdom; School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Sharon Norman
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Jan Trojanowski
- Critical Care Transport Program, British Columbia Emergency Health Services, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew W Shih
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Deaver KS, Cone DC, Rhone AM, Kupas DF. The Clinical Role and Activity of Advanced Clinicians in the Out-of-Hospital Environment. PREHOSP EMERG CARE 2021; 26:682-688. [PMID: 34477480 DOI: 10.1080/10903127.2021.1976330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Recent evolution of the EMS system has resulted in an increased role for specially trained advanced clinicians (physicians, physician assistants, and registered nurses) in out-of-hospital field response. Despite this expansion into the out-of-hospital environment there is a lack of data regarding the actual clinical roles and activity of these clinicians in the United States. We seek to describe the clinical roles of advanced clinicians in the field through description of skills used during both 9-1-1 field responses and interfacility transports in the state of Pennsylvania. Methods: Our data were taken from existing Pennsylvania Department of Health EMS records for all 9-1-1 and interfacility requests for service from January 2018 through June 2020. Descriptive statistics were applied to skills used, medications administered, clinician activity data, and patient demographics for each clinician type in four response categories: 9-1-1 air, 9-1-1 ground, interfacility air, and interfacility ground. Results: There were few statistically significant differences in skill or medication usage between clinician types. There were no statistically significant differences in level of skills (basic life support, ALS, or specialty skills) performed between clinician levels. Patient demographics for each clinician type were similar. Conclusions: Our findings indicate advanced clinicians provide care at the ALS and specialty care levels in similar patient populations with little difference in the roles between clinician types in the out-of-hospital environment. Our data demonstrate successful integration of advanced clinicians into the out-of-hospital environment in Pennsylvania and provide a framework for future planning and expansion of these roles and responsibilities.
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Affiliation(s)
- Kyle S Deaver
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| | - David C Cone
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| | - Aaron M Rhone
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
| | - Douglas F Kupas
- Received June 1, 2021 from Yale School of Medicine, Yale University, New Haven, Connecticut (KSD, DCC); Pennsylvania Department of Health, Bureau of EMS, Harrisburg, Pennsylvania (AMR); Division of EMS, Geisinger Health System, Danville, Virginia (DFK). Revision received August 13, 2021; accepted for publication August 30, 2021
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Abstract
PURPOSE OF REVIEW Posttraumatic bleeding following major trauma is life threatening for the patient and remains a major global health issue. Bleeding after major trauma is worsened by trauma-induced coagulopathy (TIC). TIC consists of acute trauma coagulopathy and resuscitation coagulopathy. The early diagnosis and management of prehospital TIC management are challenging. RECENT FINDINGS Concepts for early diagnosis and management of civilian prehospital TIC management are evolving. The feasibility of prehospital blood component as well as coagulation factor transfusion has been proven. SUMMARY Due to different national guidelines and regulations of blood component therapies there is a wide heterogeneity in concepts of prehospital damage control resuscitation. Tranexamic acid administration is widely accepted, whereas the transfusion of whole blood, blood components, or coagulations factors needs further examination in the civilian setting.
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