In-flight blood transfusions increase survival rates and improve trauma patient outcomes

Air-lifted trauma victims who received blood transfusions in the helicopter before arriving at a trauma center had higher one-day survival rates and less chance of shock than air-lifted patients who did not receive blood transfusions until they arrived at the trauma unit, according to study findings published online in the Journal of the American College of Surgeons.

The researchers evaluated the air medical evacuation strategy at the University of Pittsburgh Medical Center (UPMC), which has a network of 18 helicopter bases in Pennsylvania, Ohio, and Maryland. It is the largest study to date of a civilian in-flight trauma resuscitation protocol that has been used by the military in Iraq and Afghanistan.

The STAT MedEvac helicopter teams at UPMC have been carrying blood for transfusion on their flights for about two decades, but this is the first study that evaluated the use of transfused blood in civilian trauma victims air-evacuated directly from the injury scene and compared them with air-evacuated trauma victims who did not receive transfused blood.

Hemorrhage is the leading cause of death in trauma victims. Early transfusions of red blood cells have been known to reduce the chance of death, and the use of transfusions before trauma victims arrive at the trauma center has been growing. The study aimed to determine if pre-trauma center blood transfusions were indeed associated with improved outcomes. During a five-year period ending in 2012, 240 patients who received in-flight transfusions were evaluated in comparison with 480 who did not receive blood until they arrived at the hospital.

The UPMC protocol involves giving guidelines to paramedics and nurses onboard flights on when to administer the transfusions. All the STAT MedEvac flights at the institution carry two units of red blood cells for transfusion. Helicopter staff can communicate with the medical command doctor at the trauma center to get the go-ahead order to give blood to patients who may not meet the guidelines for transfusion but still may benefit from receiving it.