Blais-Normandin Isabelle, Rymer Tihiro, Feenstra Shelley, Burry Anne, Colavecchia Connie, Duncan Jennifer, Farrell Michael, Greene Adam, Gupta Akash, Huynh Queenie, Lawrence Robin, Lehto Paula, Lett Ryan, Lin Yulia, Lyon Bruce, McCarthy Joanna, Nahirniak Susan, Nolan Brodie, Peddle Michael, Prokopchuk-Gauk Oksana, Sham Lawrence, Trojanowski Jan, Shih Andrew W
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Alberta Precision Labs, Transfusion and Transplantation Medicine, Edmonton, Alberta, Canada.
Vox Sang. 2023 Dec;118(12):1086-1094. doi: 10.1111/vox.13542. Epub 2023 Oct 5.
Canadian out-of-hospital blood transfusion programmes (OHBTPs) are emerging, to improve outcomes of trauma patients by providing pre-hospital transfusion from the scene of injury, given prolonged transport times. Literature is lacking to guide its implementation. Thus, we sought to gather technical transfusion medicine (TM)-specific practices across Canadian OHBTPs.
A survey was sent to TM representatives of Canadian OHBTPs from November 2021 to March 2022. Data regarding transport, packaging, blood components and inventory management were included and reported descriptively. Only practices involving Blood on Board programme components for emergency use were included.
OHBTPs focus on helicopter emergency medical service programmes, with some supplying fixed-wing aircraft and ground ambulances. All provide 1-3 coolers with 2 units of O RhD/Kell-negative red blood cells (RBCs) per cooler, with British Columbia trialling coolers with 2 units of pre-thawed group A plasma. Inventory exchanges are scheduled and blood components are returned to TM inventory using visual inspection and internal temperature data logger readings. Coolers are validated to storage durations ranging from 72 to 124 h. All programmes audit to manage wastage, though there is no consensus on appropriate benchmarks. All programmes have a process for documenting units issued, reconciliation after transfusion and for transfusion reaction reporting; however, training programmes vary. Common considerations included storage during extreme temperature environments, O-negative RBC stewardship, recipient notification, traceability, clinical practice guidelines co-reviewed by TM and a common audit framework.
OHBTPs have many similarities throughout Canada, where harmonization may assist in further developing standards, leveraging best practice and national coordination.
鉴于加拿大创伤患者转运时间较长，院外输血项目（OHBTPs）正在兴起，旨在通过在受伤现场提供院前输血来改善创伤患者的治疗效果。目前缺乏指导该项目实施的文献。因此，我们试图收集加拿大各院外输血项目中输血医学（TM）的具体技术实践。
2021年11月至2022年3月，向加拿大院外输血项目的输血医学代表发送了一份调查问卷。纳入了有关运输、包装、血液成分和库存管理的数据，并进行描述性报告。仅纳入涉及应急用血的机载血液项目组件的实践。
院外输血项目主要关注直升机紧急医疗服务项目，一些项目还提供固定翼飞机和地面救护车。所有项目都提供1至3个冷藏箱，每个冷藏箱装有2单位O型RhD/凯尔血型阴性红细胞（RBCs），不列颠哥伦比亚省正在试验装有2单位解冻前A型血浆的冷藏箱。安排了库存交换，通过目视检查和内部温度数据记录器读数将血液成分返还给输血医学库存。冷藏箱经验证可储存72至124小时。所有项目都进行审核以管理浪费情况，不过对于适当的基准尚无共识。所有项目都有记录发放单位、输血后核对和输血反应报告的流程；然而，培训项目各不相同。常见的考虑因素包括极端温度环境下的储存、O型阴性红细胞管理、受血者通知、可追溯性、由输血医学共同审核的临床实践指南以及通用审核框架。
加拿大各地的院外输血项目有许多相似之处，协调一致可能有助于进一步制定标准、借鉴最佳实践并进行全国协调。
