Multicenter observational prehospital resuscitation on helicopter study
the PROHS Study Group
Trauma and Critical Care Surgery
Background: Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT).We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Methods: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHTwere compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Results: Twenty-five thousand one hundred eighteen trauma patients were admitted, 2, 341 (9%) were transported by helicopter, of which 1, 058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1, 058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasmawere transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHTwas not significantly associated with mortality at any time point, although only 10% of the high-risk sample were able to be matched. Conclusion: Because of the unexpected imbalance in systolic blood pressure, Glasgow Coma Scale, and Injury Severity Score between systems with and without blood products on helicopters, matching was limited, and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population.
Damage control resuscitation
Prehospital
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Aircraft Medicine & Life Sciences 100%
Erythrocytes Medicine & Life Sciences 26%
Glasgow Coma Scale Medicine & Life Sciences 16%
Injury Severity Score Medicine & Life Sciences 16%
Propensity Score Medicine & Life Sciences 14%
the PROHS Study Group (2017). Multicenter observational prehospital resuscitation on helicopter study. Journal of Trauma and Acute Care Surgery, 83(1), S83-S91. https://doi.org/10.1097/TA.0000000000001484
Multicenter observational prehospital resuscitation on helicopter study. / the PROHS Study Group.
In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 1, 05.04.2017, p. S83-S91.
the PROHS Study Group 2017, 'Multicenter observational prehospital resuscitation on helicopter study', Journal of Trauma and Acute Care Surgery, vol. 83, no. 1, pp. S83-S91. https://doi.org/10.1097/TA.0000000000001484
the PROHS Study Group. Multicenter observational prehospital resuscitation on helicopter study. Journal of Trauma and Acute Care Surgery. 2017 Apr 5;83(1):S83-S91. https://doi.org/10.1097/TA.0000000000001484
the PROHS Study Group. / Multicenter observational prehospital resuscitation on helicopter study. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 1. pp. S83-S91.
@article{6da4fec9000945c79b944c934ed369f4,
title = "Multicenter observational prehospital resuscitation on helicopter study",
abstract = "Background: Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT).We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Methods: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHTwere compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Results: Twenty-five thousand one hundred eighteen trauma patients were admitted, 2, 341 (9%) were transported by helicopter, of which 1, 058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1, 058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasmawere transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHTwas not significantly associated with mortality at any time point, although only 10% of the high-risk sample were able to be matched. Conclusion: Because of the unexpected imbalance in systolic blood pressure, Glasgow Coma Scale, and Injury Severity Score between systems with and without blood products on helicopters, matching was limited, and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population. ",
keywords = "Damage control resuscitation, Plasma, Prehospital, Resuscitation, Transfusion, Trauma",
author = "{the PROHS Study Group} and Holcomb, {John B.} and Swartz, {Michael D.} and DeSantis, {Stacia M.} and Greene, {Thomas J.} and Fox, {Erin E.} and Stein, {Deborah M.} and Bulger, {Eileen M.} and Kerby, {Jeffrey D.} and Michael Goodman and Schreiber, {Martin A.} and Zielinski, {Martin D.} and Terence OKeeffe and Kenji Inaba and Tomasek, {Jeffrey S.} and Podbielski, {Jeanette M.M.} and Savitri Appana and Misung Yi and Wade, {Charles E.}",
note = "Publisher Copyright: Copyright {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved.",
pages = "S83--S91",
T1 - Multicenter observational prehospital resuscitation on helicopter study
AU - the PROHS Study Group
AU - Holcomb, John B.
AU - Swartz, Michael D.
AU - DeSantis, Stacia M.
AU - Greene, Thomas J.
AU - Fox, Erin E.
AU - Stein, Deborah M.
AU - Bulger, Eileen M.
AU - Kerby, Jeffrey D.
AU - Goodman, Michael
AU - Schreiber, Martin A.
AU - Zielinski, Martin D.
AU - OKeeffe, Terence
AU - Inaba, Kenji
AU - Tomasek, Jeffrey S.
AU - Podbielski, Jeanette M.M.
AU - Appana, Savitri
AU - Yi, Misung
AU - Wade, Charles E.
N1 - Publisher Copyright: Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
N2 - Background: Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT).We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Methods: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHTwere compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Results: Twenty-five thousand one hundred eighteen trauma patients were admitted, 2, 341 (9%) were transported by helicopter, of which 1, 058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1, 058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasmawere transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHTwas not significantly associated with mortality at any time point, although only 10% of the high-risk sample were able to be matched. Conclusion: Because of the unexpected imbalance in systolic blood pressure, Glasgow Coma Scale, and Injury Severity Score between systems with and without blood products on helicopters, matching was limited, and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population.
AB - Background: Earlier use of in-hospital plasma, platelets, and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT).We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. Methods: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from January to November 2015. Five helicopter systems had plasma and/or RBCs, whereas the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high-risk criteria were analyzed. Patients receiving PHTwere compared with patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. Results: Twenty-five thousand one hundred eighteen trauma patients were admitted, 2, 341 (9%) were transported by helicopter, of which 1, 058 (45%) met the highest-risk criteria. Five hundred eighty-five of 1, 058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and Glasgow Coma Scale (7 vs 14) was significantly lower, whereas median Injury Severity Score was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 hours (8.4% vs 3.6%), 24 hours (12.6% vs 8.9%), and 30 days (19.3% vs 13.3%). Twenty-four percent of eligible patients received a PHT. A median of 1 unit of RBCs and plasmawere transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs, and 69% received both. In the propensity score matching analysis (n = 109), PHTwas not significantly associated with mortality at any time point, although only 10% of the high-risk sample were able to be matched. Conclusion: Because of the unexpected imbalance in systolic blood pressure, Glasgow Coma Scale, and Injury Severity Score between systems with and without blood products on helicopters, matching was limited, and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population.
KW - Damage control resuscitation
KW - Plasma
KW - Prehospital
KW - Resuscitation
KW - Transfusion
SP - S83-S91