[Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services].

Die Anaesthesiologie Pub Date : 2024-11-01 Epub Date: 2024-10-02 DOI:10.1007/s00101-024-01463-9
Jens Schwietring, Dirk Wähnert, Lucas Sebastian Scholl, Karl-Christian Thies
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Abstract

Background: Exsanguination is the leading cause of preventable death in severe trauma. Immediate hemorrhage control and transfusion of blood products are critical to maintain oxygen delivery and address trauma-induced coagulopathy. While prehospital blood product transfusion (PHBT) is established in neighboring countries, the fragmented configuration of Germany's emergency medical service (EMS) infrastructure has delayed the adoption of widespread PHBT programmes. This review aims to provide an updated perspective on the evolution, international practices and research needs of PHBT within the German context.

Methods: This narrative review is based on a PubMed search using the search terms "prehospital" and "blood*". From an initial 4738 articles, 333 were directly related to PHBT and were subjected to further detailed examination. The literature, including referenced studies, was categorized into areas such as history, rationale, international practices, and evidence, and analyzed for quality.

Results: The benefit of early blood transfusion in major trauma has been established since WW1, explaining the efforts to initiate this lifesaving intervention as early as possible in the care pathway, including the prehospital field. Recent randomized trials have faced design and recruitment challenges, reflecting the complexity of the research question. These trials have yielded inconclusive results regarding the survival benefits of PHBT in civilian settings. This scenario raises doubts about the capability of randomized trials to resolve questions concerning survival advantages. Despite these difficulties, there is a discernible trend indicating potential improvements in patient outcomes. In Germany, the incidence of trauma-associated shock stands at 38 per 100,000 individuals per year. It is estimated that between 300 and 1800 patients annually possibly benefit from PHBT.

Conclusion: Prehospital Blood Transfusion appears to be promising but identifying patient groups most likely to benefit as well as the most suitable blood products remain unresolved issues. In Germany PHBT programs are not yet widely established. Paradoxically, this situation, paired with the extensive German Trauma Registry, provides a prime opportunity for comprehensive prospective cohort studies, addressing the balance between PHBT benefits, logistical feasibility, and implementation strategies. Such studies are essential for establishing guidelines and integrating PHBT efficiently into German trauma care protocols.

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[院前输血 :德国急救医疗服务的机遇与挑战]。
背景:失血过多是严重创伤中可预防死亡的主要原因。立即控制出血和输注血制品对于维持氧气输送和解决创伤引起的凝血病至关重要。虽然院前血制品输注(PHBT)已在周边国家建立起来,但德国急救医疗服务(EMS)基础设施的分散配置延迟了PHBT计划的广泛采用。本综述旨在提供有关德国 PHBT 演变、国际实践和研究需求的最新观点:这篇叙述性综述基于 PubMed 搜索,搜索关键词为 "院前 "和 "血液*"。在最初的 4738 篇文章中,有 333 篇与 PHBT 直接相关,并接受了进一步的详细审查。包括参考研究在内的文献被归类为历史、原理、国际惯例和证据等领域,并进行了质量分析:结果:自一战以来,早期输血对重大创伤的益处就已得到证实,这也解释了为什么要在包括院前现场在内的救护路径中尽早启动这一救生干预措施。近期的随机试验面临着设计和招募方面的挑战,这反映了研究问题的复杂性。这些试验对 PHBT 在民用环境中的生存益处没有得出结论。这种情况让人怀疑随机试验是否有能力解决有关生存优势的问题。尽管存在这些困难,但有一个明显的趋势表明,患者的治疗效果可能会得到改善。在德国,与创伤相关的休克发病率为每年每 10 万人中 38 例。据估计,每年有 300 到 1800 名患者可能受益于院前输血:结论:院前输血似乎很有前景,但确定最有可能受益的患者群体以及最合适的血液制品仍是悬而未决的问题。在德国,院前输血项目尚未广泛开展。矛盾的是,这种情况与广泛的德国创伤登记处相配合,为全面的前瞻性队列研究提供了一个绝佳的机会,以解决 PHBT 的益处、后勤可行性和实施策略之间的平衡问题。此类研究对于制定指导方针和将 PHBT 有效纳入德国创伤救治方案至关重要。
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