TY - JOUR
T1 - Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis
AU - Rijnhout, Tim W. H.
AU - Wever, Kimberley E.
AU - Marinus, Roy H. A. R.
AU - Hoogerwerf, Nico
AU - Geeraedts, Leo M. G.
AU - Tan, Edward C. T. H.
N1 - Publisher Copyright: © 2019 Elsevier Ltd Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background: Life-threatening haemorrhage accounts for 40% mortality in trauma patients worldwide. After bleeding control is achieved, circulating volume must be restored. Early in-hospital transfusion of blood components is already proven effective, but the scientific proof for the effectiveness of prehospital blood-component transfusion (PHBT) in trauma patients is still unclear. Objective: To systematically review the evidence for effectiveness and safety of PHBT to haemorrhagic trauma patients. Methods: CINAHL, Cochrane, EMBASE, and Pubmed were searched in the period from 1988 until August 1, 2018. Meta-analysis was performed for matched trauma patients receiving PHBT with the primary outcomes 24-hour mortality and long-term mortality. Secondary outcome measure was adverse events as a result of PHBT. Results: Trauma patients who received PHBT with simultaneous use of packed red blood cells (pRBCs) and plasma showed a statistically significant reduction in long-term mortality (OR = 0.51; 95% CI, 0.36–0.71; P < 0.0001) but no difference in 24-hour mortality (OR = 0.47, 95% CI, 0.17–1.34; P = 0.16). PHBT with individual use of pRBCs showed no difference in long-term mortality (OR = 1.18; 95% CI, 0.93–1.49; P = 0.17) or 24-hour mortality (OR = 0.92; 95% CI, 0.46–1.85; P = 0.82). In a total of 1341 patients who received PHBT, 14 adverse events were reported 1.04%, 95% CI 0.57–1.75%. Conclusions: PHBT with simultaneous use of both pRBCs and plasma resulted in a significant reduction in the odds for long-term mortality. However, based on mainly poor quality evidence no hard conclusion can be drawn about a possible survival benefit for haemorrhagic trauma patients receiving PHBT. Overall, PHBT is safe but results of currently ongoing randomised controlled trials have to be awaited to demonstrate a survival benefit. Study type: Systematic review and meta-analysis
AB - Background: Life-threatening haemorrhage accounts for 40% mortality in trauma patients worldwide. After bleeding control is achieved, circulating volume must be restored. Early in-hospital transfusion of blood components is already proven effective, but the scientific proof for the effectiveness of prehospital blood-component transfusion (PHBT) in trauma patients is still unclear. Objective: To systematically review the evidence for effectiveness and safety of PHBT to haemorrhagic trauma patients. Methods: CINAHL, Cochrane, EMBASE, and Pubmed were searched in the period from 1988 until August 1, 2018. Meta-analysis was performed for matched trauma patients receiving PHBT with the primary outcomes 24-hour mortality and long-term mortality. Secondary outcome measure was adverse events as a result of PHBT. Results: Trauma patients who received PHBT with simultaneous use of packed red blood cells (pRBCs) and plasma showed a statistically significant reduction in long-term mortality (OR = 0.51; 95% CI, 0.36–0.71; P < 0.0001) but no difference in 24-hour mortality (OR = 0.47, 95% CI, 0.17–1.34; P = 0.16). PHBT with individual use of pRBCs showed no difference in long-term mortality (OR = 1.18; 95% CI, 0.93–1.49; P = 0.17) or 24-hour mortality (OR = 0.92; 95% CI, 0.46–1.85; P = 0.82). In a total of 1341 patients who received PHBT, 14 adverse events were reported 1.04%, 95% CI 0.57–1.75%. Conclusions: PHBT with simultaneous use of both pRBCs and plasma resulted in a significant reduction in the odds for long-term mortality. However, based on mainly poor quality evidence no hard conclusion can be drawn about a possible survival benefit for haemorrhagic trauma patients receiving PHBT. Overall, PHBT is safe but results of currently ongoing randomised controlled trials have to be awaited to demonstrate a survival benefit. Study type: Systematic review and meta-analysis
KW - Blood components
KW - Prehospital
KW - Transfusion
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85063378511&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.injury.2019.03.033
DO - https://doi.org/10.1016/j.injury.2019.03.033
M3 - Review article
C2 - 30928164
SN - 0020-1383
VL - 50
SP - 1017
EP - 1027
JO - Injury
JF - Injury
IS - 5
ER -