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Randomized Trial Show No Benefit for Pre-hospital Blood Transfusions in Patients with Severe Trauma

March 15, 2022

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:

  1. 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 
  2. Thies K and Ruetzler K. Prehospital blood transfusion:  who benefits?  The Lancet Haematology 2022 

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