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Efficacy and Safety of Prehospital Blood Transfusion in Traumatized Patients: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  16 December 2024

Abdelelah Abdelgadir Hamed Open the ORCID record for Abdelelah Abdelgadir Hamed [Opens in a new window] ,
Sharfeldin Mohammed Shuib Open the ORCID record for Sharfeldin Mohammed Shuib [Opens in a new window] ,
Amal Mohamed Elhusein ,
Hammad Ali Fadlalmola Open the ORCID record for Hammad Ali Fadlalmola [Opens in a new window] ,
Omnia Abdalla Higazy Open the ORCID record for Omnia Abdalla Higazy [Opens in a new window] ,
Insaf Hassan Mohammed Open the ORCID record for Insaf Hassan Mohammed [Opens in a new window] ,
Bahja Siddig Mohamed Open the ORCID record for Bahja Siddig Mohamed [Opens in a new window] ,
Mohammed Abdelmalik Open the ORCID record for Mohammed Abdelmalik [Opens in a new window] ,
Khaled Mohammed Al-Sayaghi Open the ORCID record for Khaled Mohammed Al-Sayaghi [Opens in a new window]  and
Abdalrahman Abdullatif Mohmmed Saeed Open the ORCID record for Abdalrahman Abdullatif Mohmmed Saeed [Opens in a new window]
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Abdelelah Abdelgadir Hamed
Affiliation:
College of Nursing, Department of Medical-Surgical Nursing, Najran University, Saudi Arabia
Sharfeldin Mohammed Shuib
Affiliation:
College of Nursing, Department of Medical-Surgical Nursing, Najran University, Saudi Arabia
Amal Mohamed Elhusein
Affiliation:
College of Applied Medical Science, Department of Nursing, University of Bisha, Saudi Arabia
Hammad Ali Fadlalmola
Affiliation:
Nursing College, Department of Community Health Nursing, Taibah University, Saudi Arabia
Omnia Abdalla Higazy
Affiliation:
College of Nursing, Jazan University, Saudi Arabia
Insaf Hassan Mohammed
Affiliation:
College of Nursing, Jazan University, Saudi Arabia
Bahja Siddig Mohamed
Affiliation:
College of Applied Medical Science, Jazan University, Saudi Arabia
Mohammed Abdelmalik*
Affiliation:
Al-Rayan Private College of Health Sciences and Nursing, Al Madinah Al Munawarah, Saudi Arabia
Khaled Mohammed Al-Sayaghi
Affiliation:
Department of Medical-Surgical Nursing, College of Nursing, Taibah University, Saudi Arabia
Abdalrahman Abdullatif Mohmmed Saeed
Affiliation:
College of Applied Medical Science, Nursing Department, King Faisal University, Saudi Arabia
Samya Mohamed Hegazy
Affiliation:
College of Applied Medical Sciences, Nursing Department, Al Jouf University, Saudi Arabia
Saud Albalawi
Affiliation:
Ministry of Health, Al Badrani Healthcare Center, Almadinah AlMinawwarah, Saudi Arabia
Abdullah Alrashidi
Affiliation:
Ministry of Health, General Director Infection Control, Almadinah AlMinawwarah, Saudi Arabia
Mohamed Abdallah
Affiliation:
Al-Rayan Private College of Health Sciences and Nursing, Al Madinah Al Munawarah, Saudi Arabia
*
Correspondence: Mohammed Abdelmalik, RN, MSc, PhD Al-Rayan Private College of Health Sciences and Nursing Al Madinah Al Munawarah, Saudi Arabia E-mails: [email protected]; [email protected]
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Abstract

Background:

Approximately five million individuals have traumatic injuries annually. Implementing prehospital blood-component transfusion (PHBT), encompassing packed red blood cells (p-RBCs), plasma, or platelets, facilitates early hemostatic volume replacement following trauma. The lack of uniform PHBT guidelines persists, relying on diverse parameters and physician experience.

Aim:

This study aims to evaluate the efficacy of various components of PHBT, including p-RBCs and plasma, on mortality and hematologic-related outcomes in traumatic patients.

Methods:

A comprehensive search strategy was executed to identify pertinent literature comparing the transfusion of p-RBCs, plasma, or a combination of both with standard resuscitation care in traumatized patients. Eligible studies underwent independent screening, and pertinent data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI).

Results:

Forty studies were included in the qualitative analysis, while 26 of them were included in the quantitative analysis. Solely P-RBCs alone or combined with plasma showed no substantial effect on 24-hour or long-term mortality (RR = 1.13; 95% CI, 0.68 - 1.88; P = .63). Conversely, plasma transfusion alone exhibited a 28% reduction in 24-hour mortality with a RR of 0.72 (95% CI, 0.53 - 0.99; P = .04). In-hospital mortality and length of hospital stay were mostly unaffected by p-RBCs or p-RBCs plus plasma, except for a notable three-day reduction in length of hospital stay with p-RBCs alone (MD = -3.00; 95% CI, -5.01 to -0.99; P = .003). Hematological parameter analysis revealed nuanced effects, including a four-unit increase in RBC requirements with p-RBCs (MD = 3.95; 95% CI, 0.69 - 7.21; P = .02) and a substantial reduction in plasma requirements with plasma transfusion (MD = -0.73; 95% CI, -1.28 to -0.17; P = .01).

Conclusion:

This study revealed that plasma transfusion alone was associated with a substantial decrease in 24-hour mortality. Meanwhile, p-RBCs alone or combined with plasma did not significantly impact 24-hour or long-term mortality. In-hospital mortality and length of hospital stay were generally unaffected by p-RBCs or p-RBCs plus plasma, except for a substantial reduction in length of hospital stay with p-RBCs alone.

Keywords

meta-analysisprehospital blood transfusionsystematic reviewtraumatized patients
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 39 , Issue 5 , October 2024 , pp. 324 - 334
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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Footnotes

Editor’s Note: This manuscript was peer-reviewed, revised, and accepted under the Emeritus Editor-in-Chief (EIC) of the journal, Dr. Sam Stratton. The current EIC, Dr. Jeffrey Franc, acknowledges Dr. Stratton’s contributions in relation to the acceptance and publication of this article.

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