Exsanguination is the leading cause of death in trauma patients, but there are several strategies to reduce mortality including minimal crystalloid use, transfusing a high ratio of plasma and platelets to red blood cells (RBCs), and massive transfusions protocols.
A retrospective study of trauma patients transported by air matched 240 patients receiving RBC transfusions prior to arriving at the trauma center to 480 trauma patient controls in order to determine if early, rapid RBC transfusions were beneficial. After adjusting for cofounding, RBC transfusions prior to arriving at the trauma center were associated with nearly a 5-fold increase in odds of survival at 24 hours, and a 72% reduction in the odds of shock. In addition, intervention arm patients required fewer RBC units over the first 24 hours after admission. However, RBC transfusion prior to arrival was not significantly associated with increased odds of in-hospital survival. RBC transfusion prior to arriving at the trauma center may lead to improved outcomes in severe cases.
1. Brown JB, Sperry JL, Fombona A, Billiar TR, Peitzman AB, Guyette FX. Pre-trauma center red blood cell transfusion is associated with improved early outcomes in air medical trauma patients. J Am College of Surgeons 2015; doi: 10.1016/j.jamcollsurg.2015.01.006.