Yazer M H, Spinella P C, Allard S, Roxby D, So-Osman C, Lozano M, Gunn K, Shih A W-Y, Stensballe J, Johansson P I, Bagge Hansen M, Maegele M, Doughty H, Crombie N, Jenkins D H, McGinity A, Schaefer R M, Martinaud C, Shinar E, Strugo R, Chen J, Russcher H
Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
Pediatric Critical Care Translational Research Program, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO, USA.
Vox Sang. 2018 Oct;113(7):701-706. doi: 10.1111/vox.12678. Epub 2018 Aug 24.
While specific practices and transported blood products vary around the world, most of the respondents in this International Forum transported at least one blood product for the transfusion to bleeding patients en route to the hospital. The most commonly carried product was RBCs, while the use of whole blood will likely increase given the recent reports of its successful use in the civilian setting, and because of the change in the AABB's Standards regulating its use. It will be interesting to see if plasma use in the prehospital setting becomes more widely used given today's enhanced appreciated of the coagulopathy of trauma and plasma's beneficial effect in reversing it, and if blood products are transported to the scene of injury by more vehicles, that is, not just predominantly in helicopters. It was not surprising that TXA is being widely administered as close to the time of injury as possible given its potential benefit in these patients. This International Forum highlights the importance of focusing attention on prehospital transfusion management with a need to further high‐quality research in this area to guide optimal resuscitation strategies.
虽然世界各地的具体做法和运输的血液制品各不相同,但在本次国际论坛中,大多数受访者在将出血患者送往医院的途中至少运输一种用于输血的血液制品。最常运输的产品是红细胞,鉴于最近有报道称全血在民用环境中成功使用,以及美国血库协会(AABB)关于全血使用规定的变化,全血的使用可能会增加。鉴于如今对创伤性凝血病的认识加深以及血浆在逆转该病症方面的有益作用,院前环境中血浆的使用是否会更广泛,以及血液制品是否由更多车辆运送到受伤现场,即不仅仅主要通过直升机运输,这将是很有趣的观察点。鉴于氨甲环酸(TXA)对这些患者可能有益,在尽可能接近受伤时间广泛使用TXA并不奇怪。本次国际论坛强调了关注院前输血管理的重要性,有必要在该领域进一步开展高质量研究以指导最佳复苏策略。