Pro-Con Debate

Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Roman Dudaryk, MD; Catherine Heim, MD; Kurt Ruetzler, MD, PhD, FAHA; Evan G. Pivalizza, MBChB, FFASA

Disclosures

Anesth Analg. 2022;134(4):678-682. 

In This Article

Abstract and Introduction

Abstract

Exsanguination is the leading cause of death in severely injured patients; nevertheless, prehospital blood transfusion (PHT) remains a controversial topic. Here, we review the pros and cons of PHT, which is now routine in treatment of military trauma patients in the civilian setting. While PHT may improve survival in those who suffer blunt injury or require prolonged transport from the site of injury, PHT for civilian trauma generally is not supported by high-quality evidence. This article was originally presented as a pro-con debate at the 2020 meeting of the European Society of Anesthesiology and Intensive Care.

Introduction

Exsanguination remains the leading cause of preventable mortality in the severely injured military and civilian trauma patients, with largest number of deaths occurring before hospital arrival.[1,2] Administration of blood products to a hemorrhaging patient at the earliest opportunity makes intuitive sense. Transfusion therapy close to the time of injury is intended to prevent or reverse acute traumatic coagulopathy, restore oxygen carrying capacity, and minimize crystalloid administration.[3,4] Recently, the concept of prehospital transfusion (PHT) has been introduced into civilian trauma and was received with great enthusiasm.[5] Because of the unmet medical need to improve care of traumatic hemorrhage, some jurisdictions have adopted PHT strategies, which were supported largely by retrospective and observational data. Nevertheless, we practice evidence-based rather than enthusiasm-based medicine. Since transfusion of blood products is not without risk and requires utilization of a precious and potentially limited resource, we should carefully examine the current evidence of PHT with diligence and objectivity to establish which patients may benefit, if any. Here, we review the literature on PHT and its place in damage control resuscitation (DCR) strategies, starting with studies in military populations where PHT was developed and followed by more recent investigations in civilian populations, pointing to findings that support or challenge adoption of PHT. Anesthesiologists play an integral role in DCR strategies and should be aware of strengths and weaknesses of current evidence, guidelines, and best practice recommendations.

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