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Even Minor Blood Transfusion Delays Increase Trauma Death Rates

CINCINNATI — Even minor delays as little as 10 minutes in administering packed red blood cells (pRBC) can increase the risk of death from trauma, according to a recent study that suggests expedient prehospital and emergency department transfusion capabilities could improve outcomes.

The research, published recently in the Journal of Trauma and Acute Care Surgery, notes that hemorrhage is a leading cause of death in traumatically injured patients but that evidence about the effectiveness of earlier administration of pRBC to improve outcomes is limited.

"More than 180,000 people die from trauma every year," explained lead author Elizabeth Powell, MD, assistant professor of emergency medicine in the University of Cincinnati Department of Medicine. "Bleeding is the major cause of preventable death after trauma."

For the study, researchers tracked trauma patients transported from the injury location via Air Care to the University of Cincinnati Medical Center (UCMC) and who received at least one unit of blood within 24 hours of arriving at the hospital. Participants included 94 patients, average age of 43, mostly male Caucasians who had sustained blunt force injuries between March 11, 2010 and Oct. 30, 2013. Median injury severity score was 29, and about a third of the patients died within 30 days after injury.

The helicopter service carries two units of pRBCs for protocol-driven prehospital transfusion, according to the report, and 87% of the patients received their first pRBC transfusion during transport or within one hour of ED arrival.

For those trauma victims, results controlling for trauma score-injury severity score (TRISS) indicate that each 10-minute increase in time to transfusion increased mortality risk, with an odds ratio of 1.27.

“Air Care is the only helicopter in the area to carry blood (and plasma), so we had the research platform to study how early blood transfusions impact outcomes," Powell pointed out in a University of Cincinnati press release, adding that most patients received their first blood transfusion from Air Care or within one hour of getting to UCMC.

Noting that each 10-minute delay in receiving blood increased the chance of death for these patients, Powell suggested that “shortening the time to transfusion, including having blood available in the prehospital setting, may improve outcomes.”

While she said she does not anticipate a change in ED guidelines, Powell noted that “other critical care transport services may need to examine their protocols and consider the use of blood products in their practice." Few critical care transport services currently carry blood products, she said.

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