Pre-hospital blood transfusion in non-traumatic major haemorrhage: a retrospective observational study

Blood component administration for major traumatic haemorrhage is established clinical practice in pre-hospital emergency medicine. However, transfusion practices for non-traumatic haemorrhage lack specific guidance. We analysed historical data on non-traumatic major haemorrhage to describe the incidence and current blood product administration practices.

This retrospective observational cohort study reviewed Air Ambulance Charity Kent Surrey Sussex patient data from 11 November 2013 to 9 August 2024. The cohort included patients receiving pre-hospital blood components for non-traumatic major haemorrhage. Data included demographics, haemorrhage aetiology, physiology, transfusion volumes, cardiac arrest incidence, and intra-arrest transfusion.

Fifty patients were identified, median age was 48 years (IQR 32-64). Gastrointestinal (GI) bleeding was most common (n = 21). Mean presenting systolic blood pressure (SBP) triggering transfusion was 79 mmHg. High-risk bleeding characteristics such as abdominal aortic anneursym required substantial transfusion volumes (median 4 units packed red blood cells). Pre-transfusion shock index significantly improved from 1.39 to 0.97 post-transfusion (p < 0.001).

Pre-hospital blood transfusion improved patient physiology in our cohort of non-traumatic haemorrhage patients. Patients with non-traumatic haemorrhage may benefit from a pre-hospital transfusion.