The effect of prehospital blood products on unexpected survival: A multi-institution study.

Background

Survival prediction models use arrival vital signs, rather than prehospital (PH) vital signs to estimate expected survival of injured patients. Prehospital blood product transfusion (PHBPT) has been associated with improvement in shock index (SI) during transport. The objective of this study was to examine the effect of PHBPT on expected and observed survival.

Methods

Retrospective review of patients from two level 1 trauma centers between July 2017 and July 2021 was performed. Center A provided PHBPT, whereas Center B began transfusion upon arrival to the trauma bay. Patients were stratified by timing of blood resuscitation (PHBPT vs. no PHBPT). Primary outcome of interest was expected survival based on Trauma Injury Severity Score (TRISS). Multivariate logistic regression was used to identify factors associated with unexpected survival.

Results

Of 1,139 patients included from the two centers (981 PHBPT, 158 no PHBPT), patients receiving PHBPT were more severely injured (ISS 27 vs. 19) and demonstrated higher scene SI (1.12 vs. 1.00); p < 0.05. On arrival, patients receiving PHBPT demonstrated greater improvements in SI (0.1 vs. 0.007, p = 0.017). Those receiving PHBPT had significantly more unexpected survivors calculated using PH (13% vs. 4%, p < 0.001), and arrival TRISS (15% vs. 7%, p < 0.004) compared with those receiving no PHBPT. On multivariate regression, the use of PHBPT was associated with increased odds of unexpected survival with both PH and arrival TRISS scores (Table).

Conclusion

In this multi-institution study, the use of PHBPT was associated with improved shock index at emergency department presentation and an increase in unexpected survivors. The use of emergency department vital signs in mortality prediction models may not capture the benefits of PH blood resuscitation.

Level of evidence

Retrospective comparative study without negative criteria, Study type: Prognostic; Level III.

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