Prehospital Blood Transfusions in Non-Trauma Patients.

Autor: Thiels CA; Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA.; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA., Aho JM; Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA.; Biomedical Engineering and Physiology, Rochester, MN, USA., Fahy AS; Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA., Parker ME; Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA., Glasgow AE; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA., Berns KS; Medical Transport, Mayo Clinic, Rochester, MN, USA., Habermann EB; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA., Zietlow SP; Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA., Zielinski MD; Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA. Zielinski.Martin@mayo.edu.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2016 Oct; Vol. 40 (10), pp. 2297-304.
DOI: 10.1007/s00268-016-3572-4
Abstrakt: Introduction: Despite advances in trauma care, hemorrhage continues to be the leading cause of preventable mortality in trauma. The evidence to support its use in non-trauma patients is limited. We aim to report our experience with prehospital blood product transfusion. We hypothesize that it is safe, appropriately utilized, and that our protocol, which was designed for trauma patients, is adaptable to fit the needs of non-trauma patients.
Methods: Patients transfused with blood products, packed red blood cells (pRBCs) or plasma, in the prehospital environment between 2002 and 2014 were included. Trauma patients were compared to non-trauma patients using descriptive statistics.
Results: A total of 857 patients (n = 549 trauma and n = 308 non-trauma) were transfused with pRBCs (76 %, n = 654, mean 1.6 ± 1.1 units en route), plasma (53 %, n = 455, mean 1.7 ± 0.7 unit), or both (29 %, n = 252) during ground (12 %) or air (84 %) critical care transport. Mean age was 60.8 ± 21.6 years with 60.1 % (n = 515) males. Subsequently, in-hospital blood transfusions were performed in 80 % of patients, operations in 44 %, and endoscopy in 31 %. Five percent (n = 41) of patients did not require any of these interventions. Thirty-day mortality rate was 18 %, and one patient (<0.01 %) had a transfusion reaction. The majority of patients were non-trauma (n = 549, 64 %). Of the non-trauma patients, 219 (40 %) were surgical, 193 (35 %) gastrointestinal bleeds, and 137 (25 %) medical.
Conclusion: Both non-trauma and trauma patients require blood products for life threatening hemorrhage and the majority required further interventions. Further research on the benefits of transfusion among non-trauma patients is warranted.
Databáze: MEDLINE
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