INTRODUCTION: Administration of high ratios of packed red blood cells and plasma is routine practice for in-hospital trauma resuscitation. Military and civilian emergency teams are increasingly carrying pre-hospital blood products (PHBP) for trauma resuscitation. This study systematically reviewed the clinical literature in order to determine the extent to which the available evidence supports this practice.
METHODS: Bibliographic databases and other sources were searched to July 2015 using keywords and index terms related to the intervention, setting and condition. Standard systematic review methodology aimed at minimising bias was used for study selection, data extraction and quality assessment (protocol registration PROSPERO: CRD42014013794). Synthesis was mainly narrative with random effects model meta-analysis limited to mortality outcomes.
RESULTS: No prospective comparative or randomised studies were identified. Sixteen case series and eleven comparative studies were included in the review. Seven studies included mixed populations of trauma and non-trauma patients. 25/27 studies provided only very low quality evidence. No association between PHBP and survival was found (OR for mortality: 1.24, 95% CI: 0.90-1.69, P=0.19). A single study showed improved survival in the first 24 hours. No consistent physiological or biochemical benefit was identified, nor was there evidence of reduced in-hospital transfusion requirements. Transfusion reactions were rare, suggesting the short-term safety of PHBP administration.
CONCLUSIONS: While PHBP resuscitation appears logical, the clinical literature is limited, provides only poor quality evidence and does not demonstrate improved outcomes. No conclusions as to efficacy can be drawn. The results of randomised controlled trials are awaited.