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Prehospital blood transfusion: Can we agree on a standardised approach?

  • Ross Davenport
    Affiliations
    Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK

    Royal London Major Trauma Centre, Barts Health NHS Trust, London, UK
    Search for articles by this author
  • Anne Weaver
    Affiliations
    Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK

    London's Air Ambulance, Royal London Hospital, London, UK

    Royal London Major Trauma Centre, Barts Health NHS Trust, London, UK
    Search for articles by this author
  • Laura Green
    Affiliations
    Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK

    NHS Blood & Transplant, London, UK

    Royal London Major Trauma Centre, Barts Health NHS Trust, London, UK
    Search for articles by this author
      Uncontrolled bleeding accounts for a significant proportion of early traumatic deaths, and almost always occur within the first six hours of injury. In previous randomised controlled trials (RCTs) of transfusion for injured patients with major bleeding the median time to haemorrhagic death, in trauma systems with rapid transport from injury to hospital was 2-2.6 hours from admission [
      • Fox EE
      • Holcomb JB
      • Wade CE
      • Bulger EM
      • Tilley BC
      • Group PS.
      earlier endpoints are required for hemorrhagic shock trials among severely injured patients.
      ]. Acute Traumatic Coagulopathy (ATC) occurs within minutes of injury and is evident prior to the arrival of patients in hospital [
      • Floccard B
      • Rugeri L
      • Faure A
      • et al.
      Early coagulopathy in trauma patients: an on-scene and hospital admission study.
      ]. Non-blood component transfusions e.g. crystalloid, do not enable oxygen delivery to the tissues, produce haemodilution of circulating clotting factors, are non-haemostatic, and are harmful to the endothelium. Balanced resuscitation, so called damage control resuscitation which priorities red blood cells with plasma based products has been shown to have restorative effects on the endothelium, ameliorate ATC and improve survival.
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