Leech Caroline, Clarke Eleri
Deputy Clinical Lead, The Air Ambulance Service, Coventry Airport CV8 3AZ, UK.
Consultant Emergency Medicine, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
Resusc Plus. 2022 Aug 5;11:100282. doi: 10.1016/j.resplu.2022.100282. eCollection 2022 Sep.
In the United Kingdom, prehospital blood products are increasingly carried for the early resuscitation of hypovolaemia in patients who are shocked or in cardiac arrest. There is an association between hypocalcaemia and mortality in trauma patients, but no current national guidelines on the timing or dose of calcium replacement exist. The objective of this study was to establish the availability of prehospital blood products, and the current calcium replacement protocols used by UK prehospital services.
A cross sectional survey of all UK air ambulances and additional prehospital critical care organisations was conducted in April-May 2022 via an on-line questionnaire. The survey asked 11 questions about availability of prehospital blood products, calcium replacement for patients requiring prehospital blood products, and the use of point of care testing.
There was a 100% response rate with 20/22 UK air ambulances carrying blood products and five additional prehospital services identified. There were 15 different combinations of prehospital blood products. 23/25 services had a standard operating procedure for the replacement of calcium. This was recommended before any blood product administration in 5 services (22%), during or after the 1st unit in 5 services (22%), during or after the 2nd unit in 6 services (26%) and during or after the 4th unit in 7 services (30%). Only six services carried point of care testing and no services routinely used this to measure calcium levels in patients requiring prehospital blood products.
In 2022, 91% of UK air ambulances carry prehospital blood products and there is significant variation between services in the combination of blood products provided. There is no consensus on the timing or dose of calcium replacement. Further prospective research should examine the association between traumatic bleeding and ionized calcium levels before and during blood product transfusion in order to produce more robust guidelines for routine calcium replacement.
在英国，越来越多地在院前携带血液制品，用于对休克或心脏骤停患者进行低血容量的早期复苏。创伤患者的低钙血症与死亡率之间存在关联，但目前尚无关于钙剂补充时机或剂量的国家指南。本研究的目的是确定院前血液制品的可获得性，以及英国院前服务机构目前使用的钙剂补充方案。
2022年4月至5月，通过在线问卷对英国所有空中救护和其他院前重症护理组织进行了横断面调查。该调查询问了11个关于院前血液制品可获得性、需要院前血液制品患者的钙剂补充以及即时检验使用情况的问题。
回复率为100%，20/22架英国空中救护飞机携带血液制品，并确定了另外5个院前服务机构。院前血液制品有15种不同组合。23/25个服务机构有钙剂补充的标准操作程序。5个服务机构（22%）建议在输注任何血液制品之前补充钙剂，5个服务机构（22%）建议在输注第1单位血液制品期间或之后补充，6个服务机构（26%）建议在输注第2单位血液制品期间或之后补充，7个服务机构（30%）建议在输注第4单位血液制品期间或之后补充。只有6个服务机构进行即时检验，没有服务机构常规使用其来检测需要院前血液制品患者的钙水平。
2022年，91%的英国空中救护飞机携带院前血液制品，各服务机构提供的血液制品组合存在显著差异。在钙剂补充的时机或剂量方面没有共识。应进行进一步的前瞻性研究，以检验创伤性出血与输血前及输血期间离子钙水平之间的关联，从而制定更有力的常规钙剂补充指南。
