Severe hemorrhage is the leading cause of death in trauma patients. In 2018, two randomized clinical trials showed contradictory results on the benefits of pre-hospital blood transfusions in trauma patients. A new randomized clinical trial, the resuscitation with pre-hospital blood products (RePHILL), was published in The Lancet Haemotology and showed that pre-hospital blood transfusions did not reduce mortality. Specifically, 432 severe adult trauma patients (62% white, 82% male, median age 38 years) were randomized between November 2016 and January 2021 to receive either red blood cells (RBCs) and lyophilized plasma (LyoPlas) (n=209) or 0.9% sodium chloride (n=223) prior to hospitalization. Death and/or impaired lactate clearance (a biomarker for all-cause mortality in critically ill patients) within 2 hours of randomization occurred in 64% (128/199) patients in the RBC/LyoPlas arm compared to 65% (136/210) in the control arm (adjusted risk difference, -0.025% [95% C.I., -9.0 to 9.0]). Furthermore, 30-day mortality rates were similar in the RBC/LyoPlas and control arms (42% and 45%, respectively). Adverse events and transfusion complications were similar in both arms. Nevertheless, future research is needed to confirm these results and possibly identify subgroups of patients who might benefit from pre-hospital blood transfusions.
References:
- Crombie N, Doughty HA, Bishop JRB, Desai A, et al. Resuscitation with blood products in patients with trauma-related hemorrhagic shock receiving prehospital care (RePHILL): a multicenter, open-label, randomized, controlled, phase 3 trial. The Lancet Haematology 2022
- Thies K and Ruetzler K. Prehospital blood transfusion: who benefits? The Lancet Haematology 2022
