Huang Gregory S, Dunham C Michael
Trauma/Surgical Critical Care, St. Elizabeth Youngstown Hospital1044 Belmont Ave., Youngstown 44501, OH, USA.
Int J Burns Trauma. 2017 Apr 15;7(2):17-26. eCollection 2017.
The value of prehospital red blood cell (RBC) transfusion for trauma patients is controversial. The purposes of this literature review were to determine the mortality rate of trauma patients with hemodynamic instability and the benefit of prehospital RBC transfusion. A 30-year systematic literature review was performed in 2016. Eligible studies were combined for meta-analysis when tests for heterogeneity were insignificant. The synthesized mortality was 35.6% for systolic blood pressure ≤ 90 mmHg; 51.1% for ≤ 80 mmHg; and 63.9% for ≤ 70 mmHg. For patients with either hypotension or emergency trauma center transfused RBCs, the synthesized Injury Severity Score (ISS) was 27.0 and mortality was 36.2%; the ISS and mortality correlation was r = 0.766 ( = 0.0096). For civilian patients receiving prehospital RBC transfusions, the synthesized ISS was 27.5 and mortality was 39.5%. One civilian study suggested a decrement in mortality with prehospital RBC transfusion; however, patient recruitment was only one per center per year and mortality was < 10% despite an ISS of 37. The same study created a matched control subset and indicated that mortality decreased using multivariate analysis; however, neither the assessed factors nor raw mortality was presented. Civilian studies with patients undergoing prehospital RBC transfusion and a matched control subset showed that the synthesized mortality was similar for those transfused (37.5%) and not transfused (38.7%; = 0.8933). A study of civilian helicopter patients demonstrated a similar 30-day mortality for those with and without prehospital blood product availability (22% versus 21%; = 0.626). Mortality in a study of matched military patients was better for those receiving prehospital blood or plasma (8%) than the controls (20%; = 0.013). However, transfused patients had a shorter prehospital time, more advanced airway procedures, and higher hospital RBC transfusion ( < 0.05). A subset with an ISS > 16 showed similar mortality with and without prehospital RBC availability (27.6% versus 32.0%; = 0.343). Trauma patient mortality increases with the magnitude of hemodynamic instability and anatomic injury. Some literature evidence indicates no survival advantage with prehospital RBC availability. However, other data suggesting a potential benefit is confounded or likely to be biased.
院前红细胞（RBC）输注对创伤患者的价值存在争议。本文献综述的目的是确定血流动力学不稳定的创伤患者的死亡率以及院前RBC输注的益处。2016年进行了一项为期30年的系统文献综述。当异质性检验无显著差异时，将符合条件的研究合并进行荟萃分析。收缩压≤90 mmHg的患者综合死亡率为35.6%；≤80 mmHg为51.1%；≤70 mmHg为63.9%。对于低血压或在急诊创伤中心输注RBC的患者，综合损伤严重度评分（ISS）为27.0，死亡率为36.2%；ISS与死亡率的相关性为r = 0.766（P = 0.0096）。对于接受院前RBC输注的平民患者，综合ISS为27.5，死亡率为39.5%。一项平民研究表明院前RBC输注可降低死亡率；然而，每个中心每年仅招募一名患者，尽管ISS为37，但死亡率<10%。同一研究创建了一个匹配对照亚组，并表明使用多变量分析死亡率降低；然而，既未呈现评估因素也未呈现原始死亡率。对接受院前RBC输注的患者及其匹配对照亚组的平民研究表明，输注患者（37.5%）和未输注患者（38.7%；P = 0.8933）的综合死亡率相似。一项针对民用直升机患者的研究表明，有无院前血液制品供应的患者30天死亡率相似（22%对21%；P = 0.626）。一项针对匹配军事患者的研究表明，接受院前血液或血浆的患者死亡率（8%）低于对照组（20%；P = 0.013）。然而，输注患者的院前时间更短，气道操作更高级，医院RBC输注量更高（P<0.05）。ISS>16的亚组显示，有无院前RBC供应的死亡率相似（27.6%对32.0%；P = 0.343）。创伤患者的死亡率随血流动力学不稳定程度和解剖损伤程度的增加而升高。一些文献证据表明院前有RBC供应并无生存优势。然而，其他表明可能有益处的数据存在混淆或可能存在偏倚。
