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Descriptive Analysis of Blood Product Administration in Air Medical Trauma Patients

by

Daniel P. Davis, MD — Scientific Advisor/Medical director, Air Methods Corporation; Dave Olvera, BA, NRP — Director of Clinical research, Air Methods Corporation; Leslie Brown, BS, NRP, FP-C, TP-C — Clinical Base Lead – Flight Paramedic, Air Methods Corporation; Kaitlyn Price, BSN, RN, CFRN, TCRN — Flight Nurse, Air Methods Corporation; Laura Smith, BSN, RN, CFRN, CEN, EMT-P — Flight Nurse, Air Methods Corporation

Abstract

Objectives: Early administration of blood products is associated with improved survival from traumatic injury. Helicopters have the ability to initiate infusion of blood products in the out-of-hospital environment, but the experience of air medical blood product administration is not well characterized. The objective of this analysis is to describe the experience of a large air medical service with out-of-hospital administration of blood products.

Methods: We performed a descriptive study with a secondary cohort analysis. This study was conducted over a two-year period (2019-2020) in a large air medical company. A total of 139 bases had access to blood products at some interval during the study period. Subjects for this analysis included all trauma patients receiving one or more of the following blood products in the out-of-hospital setting: packed red blood cells (PRBCs), whole blood (WB), fresh-frozen or liquid plasma (plasma), platelets. Data collected for each subject included: demographics, scene/interfacility, blood products administered, and vital signs before and after blood product administration. Data were presented descriptively. In addition, initial and final vital signs were compared to assess the effect of blood product administration. Finally, we compared scene calls to interfacility transports with regard to demographic data, blood product administration, and vital signs. Descriptive data were reported using mean or frequency with 95% confidence intervals. T-testing and chi-square analysis were used for all comparisons, with statistical significance set for p<0.05.

Results: Over the two-year study period, a total of 1587 trauma patients [1504 adult, 83 pediatric] receiving out-of-hospital blood products were identified for analysis. These included 1010 scene calls and 577 interfacility transports. A total of 1152 patients (72.6%) were male. The distribution of blood products included: 647 patients (40.8%) received PRBCs alone; 65 patients (4.1%) received WB alone; 312 patients (19.7%) received plasma alone; 544 patients (34.3%) received PRBCs/plasma; 2 patients (0.1%) received WB/PRBCs; 3 patients (0.2%) received WB/plasma; 6 patients (0.4%) received platelets alone; 5 patients (0.3%) received platelets/PRBCs; 3 patients (0.2%) received PRBCs/plasma/platelets. Interfacility transport patients were more likely than scene call patients to receive PRBCs. An increase in blood pressure (+4 mmHg) and decrease in heart rate (-8 beats/min) were observed following blood product administration. A greater improvement in blood pressure and decrease in heart rate were observed for scene call versus interfacility patients following blood administration.

Conclusions: Blood product administration appears to be an important component of air medical transport, with substantial number of trauma patients receiving some combination of PRBCs, WB, plasma, and platelets. Improvements in vital signs were observed, particularly in scene call patients. These data give valuable insight into the out-of-hospital administration of blood products by air medical providers.

Click below to read the full research paper published by the 2021 Critical Care Transport Medicine Conference Scientific Forum and the Air Medical Journal, Volume 41, 2022, Pages 23-27