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The journal of trauma and acute care surgery
07, 2017;83 (1 Suppl 1): S83-S91.

Multicenter observational prehospital resuscitation on helicopter study.

John B Holcomb, Michael D Swartz, Stacia M DeSantis, Thomas J Greene, Erin E Fox, Deborah M Stein, Eileen M Bulger, Jeffrey D Kerby, Michael Goodman, Martin A Schreiber, Martin D Zielinski, Terence O'Keeffe, Kenji Inaba, Jeffrey S Tomasek, Jeanette M Podbielski, Savitri N Appana, Misung Yi, Charles E Wade, PROHS Study Group
Author Information
  1. John B Holcomb: From 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.
PMID: 28383476 DOI: 10.1097/TA.0000000000001484

Abstract

BACKGROUND: Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter.
METHODS: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHT were compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores.
RESULTS: Twenty-five thousand one hundred eighteen trauma patients were admitted, 2,341 (9%) were transported by helicopter, of which 1,058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1,058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHT was not significantly associated with mortality at any time point, although only 10% of the high-risk sample were able to be matched.
CONCLUSION: Because of the unexpected imbalance in systolic blood pressure, Glasgow Coma Scale, and Injury Severity Score between systems with and without blood products on helicopters, matching was limited, and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population.
LEVEL OF EVIDENCE: Level II.

References

US Army Med Dep J. 2011 Apr-Jun;:18-24 [PMID: 21607903]
Hematology Am Soc Hematol Educ Program. 2013;2013:656-9 [PMID: 24319247]
Ann Surg. 2013 Feb;257(2):330-4 [PMID: 23291661]
J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S26-30 [PMID: 26002260]
Transfusion. 2013 Jan;53 Suppl 1:9S-16S [PMID: 23301981]
Transfusion. 2016 Apr;56 Suppl 2:S107-9 [PMID: 27100745]
Shock. 2014 May;41 Suppl 1:39-43 [PMID: 24662780]
Surgery. 2015 Dec;158(6):1686-95 [PMID: 26210224]
Ann Surg. 2011 Oct;254(4):598-605 [PMID: 21918426]
J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S48-53 [PMID: 26002263]
J Trauma Acute Care Surg. 2012 Mar;72(3):567-73; discussion 573-5; quiz 803 [PMID: 22491538]
J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S445-52 [PMID: 23192068]
Shock. 2014 May;41 Suppl 1:44-6 [PMID: 24296431]
J Trauma. 2007 Feb;62(2):307-10 [PMID: 17297317]
Vox Sang. 2016 Jan;110(1):36-50 [PMID: 26178308]
J Trauma Acute Care Surg. 2012 Jan;72(1):106-11 [PMID: 22310123]
Transfusion. 2009 Dec;49(12):2625-30 [PMID: 19682333]
Shock. 2014 May;41 Suppl 1:35-8 [PMID: 24317352]
Blood. 2014 Nov 13;124(20):3052-8 [PMID: 25293771]
J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S2-6 [PMID: 26002259]
Shock. 2016 Jul;46(1):3-16 [PMID: 26825635]
Transfusion. 2010 Feb;50(2):493-500 [PMID: 19804568]
Vox Sang. 2009 Jul;97(1):39-49 [PMID: 19392782]
Ann Surg. 2015 Mar;261(3):586-90 [PMID: 25072443]
Injury. 2017 Jan;48(1):5-12 [PMID: 27847192]
J Trauma Acute Care Surg. 2012 Aug;73(2 Suppl 1):S49-53 [PMID: 22847094]
JAMA. 2015 Feb 3;313(5):471-82 [PMID: 25647203]
J Trauma. 2009 Apr;66(4 Suppl):S77-84; discussion S84-5 [PMID: 19359974]
J Spec Oper Med. 2014 Fall;14(3):13-38 [PMID: 25344706]
J Trauma Acute Care Surg. 2013 Jun;74(6):1425-31 [PMID: 23694868]
Shock. 2014 May;41 Suppl 1:3-12 [PMID: 24430539]
JAMA Surg. 2013 Feb;148(2):127-36 [PMID: 23560283]
Prehosp Emerg Care. 2015 January-March;19(1):1-9 [PMID: 24932734]
Transfusion. 2013 Jan;53 Suppl 1:59S-64S [PMID: 23301974]
Transfusion. 2013 Dec;53(12):3088-99 [PMID: 23614333]
J Trauma. 2007 Oct;63(4):805-13 [PMID: 18090009]
JAMA. 2012 Apr 18;307(15):1602-1610 [PMID: 22511688]
Ann Surg. 2008 Sep;248(3):447-58 [PMID: 18791365]
Shock. 2013 Dec;40(6):444-50 [PMID: 24089000]
Surgery. 2016 Mar;159(3):947-59 [PMID: 26603848]
J Am Coll Surg. 2015 May;220(5):797-808 [PMID: 25840537]
Ann Surg. 2015 May;261(5):997-1005 [PMID: 24670858]
Br J Anaesth. 2015 Jul;115(1):76-83 [PMID: 25991760]
J Trauma. 2008 Aug;65(2):272-6; discussion 276-8 [PMID: 18695461]
Vox Sang. 2007 Jan;92(1):69-78 [PMID: 17181593]
Aviat Space Environ Med. 2014 Nov;85(11):1130-5 [PMID: 25329947]
Anesth Analg. 2017 Jan;124(1):277-281 [PMID: 27749352]
Psychol Methods. 2004 Dec;9(4):403-25 [PMID: 15598095]
J Trauma Acute Care Surg. 2016 Oct;81(4):780-94 [PMID: 27389129]
Ann Surg. 2014 Jul;260(1):13-21 [PMID: 24651132]
J Trauma Acute Care Surg. 2012 Aug;73(2 Suppl 1):S89-94 [PMID: 22847102]
JAMA Surg. 2013 Feb;148(2):170-5 [PMID: 23426594]
Transfusion. 2016 Apr;56 Suppl 2:S157-65 [PMID: 27100752]
BMJ. 2016 Jun 22;353:i3051 [PMID: 27333868]

Grants

  1. T32 GM074902/NIGMS NIH HHS
  2. U01 HL077863/NHLBI NIH HHS

MeSH Term

Adult
Air Ambulances
Blood Transfusion
Female
Hemorrhage
Humans
Injury Severity Score
Male
Middle Aged
Military Medicine
Propensity Score
Prospective Studies
Resuscitation
Survival Rate
Trauma Centers
Treatment Outcome
Journal Article Multicenter Study Observational Study

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