Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Division of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Transfusion. 2022 Aug;62 Suppl 1:S203-S210. doi: 10.1111/trf.16991. Epub 2022 Jun 26.
Prehospital blood product resuscitation after injury significantly decreases risk of mortality. However, the number of patients who may potentially benefit from this life-saving intervention is currently unknown. The primary objective of this study was to estimate the number of patients who may potentially benefit from prehospital blood product resuscitation after injury in the United States. The secondary objective was to estimate the amount of blood products needed for prehospital resuscitation of injured patients.
Patients ≥16 years with blunt/penetrating injuries included in National Emergency Medical Services Information System 2019 were identified and classified into four separate cohorts of hemodynamic instability: Cohort 1 (systolic blood pressure [SBP] <90 mmHg), Cohort 2 (SBP <90 and/or heart rate [HR] >120), Cohort 3 (SBP <90 and HR >108 or SBP <70), and Cohort 4 (shock index ≥1). The need for prehospital blood was estimated by multiplying number of patients in each cohort with average number of blood products used for prehospital resuscitation.
After exclusions, 3.7 million adult trauma patients were included. The number of patients who may potentially benefit from prehospital blood products was estimated as 89,391 (Cohort 1), 901,346 (Cohort 2), 54,160 (Cohort 3), and 300,475 (Cohort 4). Assuming 1 unit of whole blood is needed per patient, a lower-bound estimate of 54,160 additional whole blood units (0.6% of current collections) will be need for prehospital resuscitation of the injured.
Annually, between 54,000 and 900,000 patients may potentially benefit from prehospital blood product resuscitation after injury in the United States. Prehospital blood utilization and collection of blood products will need to be increased to scale-up this life-saving intervention nationwide.
创伤后进行院前血液制品复苏可显著降低死亡率。然而，目前尚不清楚有多少患者可能受益于这种救命干预措施。本研究的主要目的是估计美国创伤后可能从院前血液制品复苏中受益的患者人数。次要目标是估计院前复苏受伤患者所需的血液制品量。
纳入国家紧急医疗服务信息系统 2019 年的年龄≥16 岁的钝器/穿透性损伤患者，并将其分为四个不同的血流动力学不稳定队列：队列 1（收缩压[SBP]＜90mmHg）、队列 2（SBP＜90mmHg 且/或心率[HR]＞120）、队列 3（SBP＜90mmHg 且 HR＞108 或 SBP＜70mmHg）和队列 4（休克指数≥1）。通过将每个队列中的患者人数乘以用于院前复苏的平均血液制品数量来估计院前用血需求。
排除后，纳入了 370 万例成年创伤患者。估计可能从院前血液制品中受益的患者人数为 89391 例（队列 1）、901346 例（队列 2）、54160 例（队列 3）和 300475 例（队列 4）。假设每位患者需要 1 单位全血，则院前复苏受伤患者还需要额外的 54160 单位全血（当前采集量的 0.6%）。
每年，美国可能有 54000 至 900000 名患者可能受益于创伤后院前血液制品复苏。需要增加院前血液制品的使用和血液制品的采集，以在全国范围内扩大这一救命干预措施。
