Prehospital use of blood transfusion to manage haemorragic shock

Abstract

Introduction Polytrauma is one of the main causes of death and disability among young healthy people, causing a significant loss of life quality and potential years of life. The main cause of early preventable death in these patients is exanguination due to blood loss. Currently, the use of crystalloids is the only way to initiate fluid resuscitation during prehospital medical attention, delaying the use of transfusion until arrival to the emergency department. This situation may delay the use of a potentially life-saving therapeutic measure in the critically injured patient. Justifcation Current measures of prehospital fluid resuscitation may be insufficient and even worse patient's situation iatrogenically when used in excessive amount. Multiple military forces have tested the use of prehospital transfusion in the critically injured patient, showing promising results. Current evidence regarding civilian use of this measure is scarce, increasing the need of testing this potentially life-saving measure in a civilian environment. Objectives To evaluate if the use of prehospital blood transfusion in severe polytrauma patients suffering haemorraghic shock is related to reduced mortality and reduced use of inhospital blood products compared to patients in similar condition before implementation of the protocol. Methodology This study will be a multicenter quasi-experimental study that will be carried out by 17 medical centers along Catalonia. The sample will be composed by two groups of severe polytrauma patients suffering haemorraghic shock: one group will be formed by patients registered in TraumCat before implementation of the protocol (control group) and the other group will be formed by patients attended by these medical centers after implementation of the protocol. Finally, mortality rate and in-hospital use of blood products will be compared between the two groups