Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis

Tim W. H. Rijnhout, Kimberley E. Wever, Roy H. A. R. Marinus, Nico Hoogerwerf, Leo M. G. Geeraedts, Edward C. T. H. Tan

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

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
Original languageEnglish
JournalInjury
DOIs
Publication statusPublished - 2019

Cite this

Rijnhout, Tim W. H. ; Wever, Kimberley E. ; Marinus, Roy H. A. R. ; Hoogerwerf, Nico ; Geeraedts, Leo M. G. ; Tan, Edward C. T. H. / Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis. In: Injury. 2019.
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title = "Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis",
abstract = "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",
author = "Rijnhout, {Tim W. H.} and Wever, {Kimberley E.} and Marinus, {Roy H. A. R.} and Nico Hoogerwerf and Geeraedts, {Leo M. G.} and Tan, {Edward C. T. H.}",
year = "2019",
doi = "10.1016/j.injury.2019.03.033",
language = "English",
journal = "Injury. International Journal of the Care of the Injured",
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Is prehospital blood transfusion effective and safe in haemorrhagic trauma patients? A systematic review and meta-analysis. / Rijnhout, Tim W. H.; Wever, Kimberley E.; Marinus, Roy H. A. R.; Hoogerwerf, Nico; Geeraedts, Leo M. G.; Tan, Edward C. T. H.

In: Injury, 2019.

Research output: Contribution to journalReview articleAcademicpeer-review

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.

PY - 2019

Y1 - 2019

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

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30928164

U2 - 10.1016/j.injury.2019.03.033

DO - 10.1016/j.injury.2019.03.033

M3 - Review article

JO - Injury. International Journal of the Care of the Injured

JF - Injury. International Journal of the Care of the Injured

SN - 0020-1383

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