Pre-hospital red cell transfusion and patient outcomes after trauma

Background In the pre-hospital phase of care in Australia, red blood cells are often the only blood component available for resuscitation of severe haemorrhagic shock. The aim of this study was to report on the practice of pre-hospital resuscitation of haemorrhagic shock using red cells without other blood components and detail patient outcomes. Methods A retrospective cohort study was performed that included patients presenting to two adult major trauma centres in Victoria, Australia, after pre-hospital administration of red cells. The primary outcome was the proportion of patients with a change in shock index from ≥1 to <1. Secondary outcomes were lactate levels, measures of coagulopathy on arrival to hospital, and mortality at hospital discharge. Results There were 243 patients included. Pre-hospital transfusion was associated with improvement in shock index among 50 (20.6%) but worsening in 41 (16.9%) patients. Among the 128 patients with pre-hospital shock index ≥1, 50 (39.1%) had a shock index <1 on arrival to the hospital. There were 68 (35.4%) patients who presented with an international normalised ratio >1.3, and the median lactate level on arrival was 3.6 (interquartile range 1.9–5.9). In-hospital mortality was reported for 70 (28.8%) patients. Conclusions Pre-hospital red cells are increasingly being used for the management of haemorrhagic shock, but a substantial proportion of patients remain in unfavourable shock index. The potential benefits of additional pre-hospital interventions using plasma, platelets, fibrinogen or whole blood require further clinical trials.