Weeber Heinrich, Hunter Luke D, van Hoving Daniël J, Lategan Hendrick, Bruijns Stevan R
Khayelitsha Hospital, Cape Town, South Africa.
Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
Afr J Emerg Med. 2018 Jun;8(2):69-74. doi: 10.1016/j.afjem.2018.01.004. Epub 2018 Mar 20.
International guidance suggests that injury-associated haemorrhagic shock should be resuscitated using blood products. However, in low- and middle-income countries resuscitation emphasises the use of crystalloids - mainly due to poor access to blood products. This study aimed to estimate the amount of blood loss from serious injury in relation to available emergency blood products at a secondary-level, public Cape Town hospital.
This retrospective, cross-sectional study included all injured patients cared for in the resuscitation area of Khayelitsha Hospital's emergency centre over a fourteen-week period. Injuries were coded using the Abbreviated Injury Scale, which was then used to estimate blood loss for each patient using an algorithm from the Trauma Audit Research Network. Descriptive statistics were used to describe blood volume lost and blood units required to replace losses greater than 15% circulating blood volume. Four units of emergency blood are stored in a dedicated blood fridge in the emergency centre. Platelets and fresh plasma are not available.
A total of 389 injury events were enrolled of which 93 were excluded due to absent clinic data. The mean age was 29 (±10) years. We estimated a median of one unit of blood requirement per week or weekend, up to a maximum of eight or six units, respectively. Most patients (n = 275, 94%) did not have sufficient injury to warrant transfusion. Overall, one person would require a transfusion for every 15 persons with a moderate to serious injury.
The volume of available emergency blood appears inadequate for injury care, and doesn't consider the need for other causes of acute haemorrhage (e.g. gastric, gynaecological, etc.). Furthermore, lack of other blood components (i.e. plasma and platelets) presents a challenge in this low-resourced setting. Further research is required to determine the appropriate management of injury-associated haemorrhage from a resource and budget perspective.
国际指南建议，与损伤相关的失血性休克应使用血液制品进行复苏。然而，在低收入和中等收入国家，复苏强调使用晶体液——主要是因为难以获得血液制品。本研究旨在估计开普敦一家二级公立医院严重损伤的失血量与可用应急血液制品的关系。
这项回顾性横断面研究纳入了在14周内于Khayelitsha医院急诊中心复苏区接受治疗的所有受伤患者。使用简略损伤量表对损伤进行编码，然后使用创伤审计研究网络的算法为每位患者估计失血量。描述性统计用于描述失血量和为补充超过循环血容量15%的损失所需的血液单位数。急诊中心的专用血液冰箱中储存有4单位应急血液。没有血小板和新鲜血浆。
共纳入389例损伤事件，其中93例因临床数据缺失而被排除。平均年龄为29（±10）岁。我们估计每周或周末的血液需求量中位数为1单位，最多分别为8单位或6单位。大多数患者（n = 275，94%）损伤程度不足以进行输血。总体而言，每15名中重度受伤患者中有1人需要输血。
可用应急血液的量似乎不足以满足损伤治疗的需求，且未考虑其他急性出血原因（如胃出血、妇科出血等）的需求。此外，在这种资源匮乏的环境中，缺乏其他血液成分（即血浆和血小板）带来了挑战。需要进一步研究从资源和预算角度确定损伤相关出血的适当管理方法。
