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Mitra B, Talarico CS, Olaussen A, Anderson D, Meadley B. Blood lactate after pre-hospital blood transfusion for major trauma by helicopter emergency medical services. Vox Sang 2024; 119:460-466. [PMID: 38357735 DOI: 10.1111/vox.13598] [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: 09/12/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVES The appropriate use of blood components is essential for ethical use of a precious, donated product. The aim of this study was to report in-hospital red blood cell (RBC) transfusion after pre-hospital transfusion by helicopter emergency medical service paramedics. A secondary aim was to assess the potential for venous blood lactate to predict ongoing transfusion. MATERIALS AND METHODS All patients who received RBC in air ambulance were transported to a single adult major trauma centre, had venous blood lactate measured on arrival and did not die before ability to transfuse RBC were included. The association of venous blood lactate with ongoing RBC transfusion was assessed using multi-variable logistic regression analysis and reported using adjusted odds ratios (aOR). The discriminative ability of venous blood lactate was assessed using area under receiver operating characteristics curve (AUROC). RESULTS From 1 January 2016 to 15 May 2019, there were 165 eligible patients, and 128 patients were included. In-hospital transfusion occurred in 97 (75.8%) of patients. Blood lactate was associated with ongoing RBC transfusion (aOR: 2.00; 95% confidence interval [CI]: 1.36-2.94). Blood lactate provided acceptable discriminative ability for ongoing transfusion (AUROC: 0.78; 95% CI: 0.70-0.86). CONCLUSIONS After excluding patients with early deaths, a quarter of those who had prehospital RBC transfusion had no further transfusion in hospital. Venous blood lactate appears to provide value in identifying such patients. Lactate levels after pre-hospital transfusion could be used as a biomarker for transfusion requirement after trauma.
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Affiliation(s)
- Biswadev Mitra
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carly S Talarico
- Alfred Health Emergency Service, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alexander Olaussen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - David Anderson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Ben Meadley
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
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Bankhead-Kendall B, Teixeira P, Roward S, Ali S, Ryder A, Sahi S, Cardenas T, Aydelotte J, Coopwood B, Brown C. Narrow pulse pressure is independently associated with massive transfusion and emergent surgery in hemodynamically stable trauma patients. Am J Surg 2020; 220:1319-1322. [DOI: 10.1016/j.amjsurg.2020.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/01/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
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Kolin DA, Shakur-Still H, Bello A, Chaudhri R, Bates I, Roberts I. Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials. PLoS One 2020; 15:e0233274. [PMID: 32492040 PMCID: PMC7269233 DOI: 10.1371/journal.pone.0233274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/30/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hemorrhage is a leading cause of death after trauma and childbirth. In response to severe hemorrhage, bleeding patients often receive transfusions of red blood cells, plasma, platelets, or other blood components. We examined risk factors for transfusion in acute severe bleeding in two trials of over 20,000 patients to better understand factors associated with transfusion likelihood. STUDY DESIGN AND METHODS We conducted a cohort analysis of data from the CRASH-2 and WOMAN trials, two multinational trials that recruited patients with traumatic and postpartum hemorrhage, respectively. For each trial, we examined the effect of 10 factors on blood transfusion likelihood. Univariate and multivariate Poisson regressions were used to analyze the relationship between risk factors and blood transfusion. RESULTS Of the 20,207 traumatic hemorrhage patients, 10,232 (51%) received blood components. Of the 20,060 women with postpartum hemorrhage, 10,958 (55%) received blood components. For patients who suffered from traumatic hemorrhage, those greater than three hours from injury to hospitalization were more likely to be transfused (ARR 1.37; 95% CI, 1.20-1.56). Postpartum hemorrhage patients had an increased likelihood of transfusion if they gave birth outside the hospital (ARR 1.30; 95% CI 1.22-1.39), gave birth more than three hours before hospitalization (ARR 1.09; 95% CI 1.01-1.17), had a Caesarean section (ARR 1.16; 95% CI 1.08-1.25), and if they had any identifiable causes of hemorrhage other than uterine atony. CONCLUSION Several risk factors are associated with an increased likelihood of transfusion in traumatic and postpartum hemorrhage patients. Altering modifiable factors, by reducing time from injury or childbirth to hospitalization, for example, might be able to reduce transfusions and their complications. TRIAL REGISTRATION CRASH-2 is registered as ISRCTN86750102, ClinicalTrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919. WOMAN is registered as ISRCTN76912190, ClinicalTrials.gov NCT00872469, PACTR201007000192283, and EudraCT number 2008-008441-38.
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Affiliation(s)
- David A. Kolin
- Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Haleema Shakur-Still
- Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Adenike Bello
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - Rizwana Chaudhri
- Department Obstetrics and Gynecology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
| | - Ian Roberts
- Department of Population Health, Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
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Figueiredo S, Taconet C, Harrois A, Hamada S, Gauss T, Raux M, Duranteau J. How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study. Ann Intensive Care 2018; 8:76. [PMID: 29980953 PMCID: PMC6035120 DOI: 10.1186/s13613-018-0420-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background The diagnostic value of hemoglobin (Hb) for detecting a significant hemorrhage (SH) in the early phase of trauma remains controversial. The present study aimed to assess the abilities of Hb measurements taken at different times throughout trauma management to identify patients with SH. Methods All consecutive adult trauma patients directly admitted to six French level-1 trauma centers with at least one prehospital Hb measurement were analyzed. The abilities of the following variables to identify SH (≥ 4 units of red blood cells in the first 6 h and/or death related to uncontrolled bleeding within 24 h) were determined and compared to that of shock index (SI): Hb as measured with a point-of-care (POC) device by the prehospital team on scene (POC-Hbprehosp) and upon patient’s admission to the hospital (POC-Hbhosp), the difference between POC-Hbhosp and POC-Hbprehosp (DeltaPOC-Hb) and Hb as measured by the hospital laboratory on admission (Hb-Labhosp). Results A total of 6402 patients were included, 755 with SH and 5647 controls (CL). POC-Hbprehosp significantly predicted SH with an area under ROC curve (AUC) of 0.72 and best cutoff values of 12 g/dl for women and 13 g/dl for men. POC-Hbprehosp < 12 g/dl had 90% specificity to predict of SH. POC-Hbhosp and Hb-Labhosp (AUCs of 0.92 and 0.89, respectively) predicted SH better than SI (AUC = 0.77, p < 0.001); best cutoff values of POC-Hbhosp were 10 g/dl for women and 12 g/dl for men. DeltaPOC-Hb also predicted SH with an AUC of 0.77, a best cutoff value of − 2 g/dl irrespective of the gender. For a same prehospital fluid volume infused, DeltaPOC-Hb was significantly larger in patients with significant hemorrhage than in controls. Conclusions Challenging the classical idea that early Hb measurement is not meaningful in predicting SH, POC-Hbprehosp was able, albeit modestly, to predict significant hemorrhage. POC-Hbhosp had a greater ability to predict SH when compared to shock index. For a given prehospital fluid volume infused, the magnitude of the Hb drop was significantly higher in patients with significant hemorrhage than in controls. Electronic supplementary material The online version of this article (10.1186/s13613-018-0420-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Figueiredo
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France. .,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France.
| | - C Taconet
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
| | - A Harrois
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
| | - S Hamada
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
| | - T Gauss
- Department of Anaesthesia and Critical Care, Beaujon Hospital, Hôpitaux Universitaires Paris-Nord Val-de-Seine, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - M Raux
- SSPI - Accueil des Polytraumatisés, Hôpital Universitaire Pitié Salpêtrière - Charles Foix, Assistance Publique - Hôpitaux de Paris, Paris, France.,INSERM UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Université Pierre et Marie Curie, Paris, France
| | - J Duranteau
- Department of Anaesthesia and Critical Care, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, University Paris-Sud, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.,Hôpitaux Universitaires Paris Sud, 94275, Le Kremlin Bicêtre, France
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