Summary
Severe out-of-hospital hemorrhagic shock: experience of the first helicopter emergency medical service equipped for transfusions in Andalusia
Affiliation of the authors
DOI
Quote
Muñoz-Álvarez E, Soto-García R, García-Márquez V, Quirós-Delgado L, Fernández-Herrera MD, Romero-Olóriz C. Severe out-of-hospital hemorrhagic shock: experience of the first helicopter emergency medical service equipped for transfusions in Andalusia. Rev Esp Urg Emerg. 2024;3:163–71
Summary
BACKGROUND. Early transfusion of packed red blood cells (PRBCs) could improve survival rates in hemorrhagic shock, but more evidence of safety and efficacy in prehospital settings is needed.
OBJECTIVE. To describe the experience of Andalusia’s first helicopter emergency medical service (HEMS) equipped to give prehospital transfusions to patients with hemorrhagic shock.
MATERIAL AND METHODS. Retrospective observational study of 13 cases in which patients were transfused with type-O PRBCs during transport by the HEMS sent from the 061 emergency dispatchers of Malaga, Spain, between March 2022 and March 2024. We analyzed demographic and clinical variables, including severity scale assessments and mortality.
RESULTS. The mean patient age was 43 years, and 92.3% were men. The majority of injuries (69.2%) occurred during traffic accidents. Most patients had severe hemorrhagic shock (initial shock index, 1.56) secondary to multiple injuries involving the thorax, abdomen, and head. A median (interquartile range) of 1 unit (1-2 units) of type-O PRBCs was transfused before arrival at the
hospital in each case. The shock index improved significantly to 1.02 (P = .0027) after prehospital transfusion, and no adverse events were registered. Overall mortality was 46.1%. The only significantly different variable between survivors and nonsurvivors was the trauma score (P = .0143). All the unused units of type-O PRBCs were reintroduced into the care circuit by the attending hospital.
CONCLUSIONS. Early prehospital transfusion of type-O PRBCs in patients in hemorrhagic shock due to severe trauma seems to be safe and potentially effective for initially stabilizing the patient and improving physiological parameters. More studies in larger cohorts are needed to confirm these preliminary findings.