Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Cologne; Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Campus Cologne-Merheim, Cologne; Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne; Department of Anaesthesiology and Intensive Care Medicine, Armed Forces Hospital Ulm, Ulm; Rescue transport helicopter (RTH) "Christoph 22" Ulm, ADAC-Air Rescue, Ulm.
Dtsch Arztebl Int. 2023 Oct 6;120(40):670-676. doi: 10.3238/arztebl.m2023.0176.
Controversy surrounds the administration of blood products to severely traumatized patients before they arrive in the hospital in order to compensate for early blood loss and/or to correct coagulation disturbances that arise shortly after the traumatic event. A number of terrestrial and air rescue services have begun to provide this kind of treatment.
This review is based on articles using the PICO framework, published from January 2001 to January 2021, that were retrieved by a selective search, with structured searching strategies and searching bundles in Medline (OVIDSP), the Cochrane Central Register of Controlled Trials (CENTRAL), and Epistemonikos. A demand analysis was carried out on the basis of data from the trauma registry of the German Society of Trauma Surgery (TR-DGU) and practical experience from program development and implementation was provided by the Bundeswehr Hospital Ulm.
The currently available evidence on the pre-hospital administration of blood products in the early treatment of severely injured patients is based largely on retrospective, single-center case series. Two randomized controlled trials (RCTs) concerning the early use of fresh frozen plasma concentrates have yielded partly conflicting results. Three further RCTs on the use of lyophilized plasma (lyplas), lyplas plus erythrocyte concentrate, or whole blood likewise revealed non-uniform effects on short-term and intermediate-term mortality. Our demand analysis based on data from the TR-DGU showed that 300 to 1800 patients per year in Germany could benefit from the pre-hospital administration of blood products. This might be indicated in patients who have systolic hypotension (<100 mmHg) in combination with a suspected or confirmed hemorrhage, as well as pathological shock parameters in the point-of-care diagnostic testing performed on the scene (serum base excess ≤ -2.5 mmol/L and/or serum lactate concentration >4 mmol/L).
The studies that have been published to date yield no clear evidence either for or against the early pre-hospital administration of blood products. Any treatment of this kind should be accompanied by scientific evaluation.
为了补偿创伤早期失血和/或纠正创伤后不久出现的凝血功能障碍，一些地面和空中救援服务已经开始提供这种治疗。
本综述基于使用 PICO 框架的文章，检索时间为 2001 年 1 月至 2021 年 1 月，通过选择性搜索，使用结构化搜索策略和 Medline（OVIDSP）、Cochrane 对照试验中心注册库（CENTRAL）和 Epistemonikos 的搜索包进行搜索。根据德国创伤外科学会（TR-DGU）创伤登记处的数据进行需求分析，并由乌尔姆联邦国防军医院提供方案制定和实施的实践经验。
目前关于严重创伤患者早期使用血制品的院前治疗的证据主要基于回顾性、单中心病例系列。两项关于早期使用新鲜冷冻血浆浓缩物的随机对照试验（RCT）得出了部分相互矛盾的结果。另外三项关于冻干血浆（lyplas）、lyplas 加红细胞浓缩物或全血使用的 RCT 也显示了对短期和中期死亡率的非一致影响。我们基于 TR-DGU 数据的需求分析表明，德国每年有 300 至 1800 名患者可能受益于院前血制品的使用。这可能适用于有收缩压<100mmHg 并伴有疑似或确诊出血的患者，以及现场进行的即时诊断测试中出现病理性休克参数（血清碱剩余≤-2.5mmol/L 和/或血清乳酸浓度>4mmol/L）的患者。
迄今为止发表的研究既没有明确的证据支持也没有反对早期院前血制品的使用。任何此类治疗都应伴随科学评估。
