Compliance with French Military Health Service guidelines for prehospital transfusion of blood products during forward aeromedical evacuations in Sahel (2015 to 2023)

INTRODUCTION: The forward transfusion guideline of the French Health Service (FHS) provides guidance for prehospital blood product (BP) transfusion in casualties' evacuations from overseas operations (OO). In Sahel, aeromedical evacuation (AE) teams are provided with lyophilized plasma, packed red blood cells (PRBC), and cold-stored low-titer group O whole blood (CS-LTOWB). The main objective was to evaluate compliance with guidelines for prehospital transfusion of severely injured trauma casualties during forward AE in OO. Secondary objectives were to identify clinical and paraclinical criteria, beyond current guidelines, associated with transfusion, and to describe the factors influencing transfusion rates. METHODS: A multicenter retrospective observational study was conducted on forward AE missions in the western Sahelian theater between January 2015 and July 2023. Two hundred and six patients evacuated for traumatic injuries, classified as category Alpha or Bravo, were included. Sixty-five percent of transfused patients did not meet the established transfusion criteria. Isolated heart rate above 110 bpm, modification of complexion, Shock Index above 1, altered mental status, penetrating trauma, pelvic trauma and effusion at Focused Assessment with Sonography for Trauma (FAST) ultrasound were more frequent within transfused patients. Median transfusion rate was about 25 mL/min [16-50]. CONCLUSION: A prospective evaluation of our findings is needed before proposing a revision to the current FHS guideline, including the addition of exclusion criteria.