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Multicenter observational prehospital resuscitation on helicopter study
John B Holcomb1, Michael D Swartz, Stacia M DeSantis
1From the Center for Translational Injury Research (J.B.H., M.D.S., E.E.F., J.S.T., J.M.P., C.E.W.), Division of Acute Care Surgery, Department of Surgery, Medical School, Department of Biostatistics, School of Public Health (M.D.S., S.M.D., T.J.G., S.A., M.Y.), University of Texas Health Science Center at Houston, Houston, Texas; R Adams Cowley Shock Trauma Center, Program in Trauma (D.M.S.), University of Maryland School of Medicine, Baltimore, Maryland; Division of Trauma and Critical Care, Department of Surgery (E.M.B.), School of Medicine, University of Washington, Seattle, Washington; Division of Trauma, Burns and Surgical Critical Care, Department of Surgery (J.D.K.), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Trauma/Critical Care, Department of Surgery (M.G.), College of Medicine, University of Cincinnati, Cincinnati, Ohio; Division of Trauma, Critical Care and Acute Care Surgery (M.A.S.), School of Medicine, Oregon Health & Science University, Portland, Oregon; Division of Trauma, Critical Care, and General Surgery (M.D.Z.), Mayo Clinic, Rochester, Minnesota; Division of Trauma, Critical Care and Emergency Surgery (T.O'K.), Department of Surgery, University of Arizona, Tucson, Arizona; and Division of Trauma and Critical Care (K.I.), University of Southern California, Los Angeles, California.
Prehospital blood product transfusion (PHT) in helicopter transport for trauma patients did not show a significant survival benefit. Due to study limitations, further large-scale randomized trials are needed to confirm findings on PHT for severe hemorrhage.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- In-hospital transfusions improve trauma survival.
- Retrospective studies suggest prehospital blood product transfusion (PHT) benefits early survival.
- This study investigated PHT's impact on helicopter-transported trauma patients.
Purpose of the Study:
- To test the hypothesis that PHT of plasma and/or red blood cells (RBCs) improves survival in helicopter-transported trauma patients.
- To compare mortality rates in high-risk trauma patients receiving PHT versus those receiving only crystalloid resuscitation.
Main Methods:
- Prospective observation of adult trauma patients transported by helicopter to Level 1 trauma centers.
- Comparison of outcomes between helicopter systems with and without prehospital blood products.
- Analysis of mortality at 3 hours, 24 hours, and 30 days using propensity score matching.
Main Results:
- Patients in systems with PHT had lower prehospital blood pressure and GCS, and higher ISS.
- Unadjusted mortality was higher in systems with PHT available at all time points.
- Propensity score matching (n=109) did not show a significant association between PHT and mortality.
Conclusions:
- Unexpected baseline imbalances limited the study's conclusions.
- The study was inconclusive regarding the survival benefit of PHT in this population.
- Large, multicenter, randomized studies are necessary to definitively assess PHT's impact on survival.
