Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T17:24:42.914Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiological and Accounting Analysis of Ground Ambulance Whole Blood Transfusion

Published online by Cambridge University Press:  18 December 2019

Julian G. Mapp Open the ORCID record for Julian G. Mapp [Opens in a new window] ,
Eric A. Bank ,
Lesley A. Osborn ,
Michael L. Stringfellow ,
David W. Reininger ,
Christopher J. Winckler  and
Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME2) Group
Julian G. Mapp*
Affiliation:
US Army Institute of Surgical Research, JBSA Fort Sam Houston, TexasUSA Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
Eric A. Bank
Affiliation:
Harris County Emergency Service District 48 Fire Department, Katy, TexasUSA
Lesley A. Osborn
Affiliation:
Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TexasUSA
Michael L. Stringfellow
Affiliation:
San Antonio Fire Department, San Antonio, TexasUSA
David W. Reininger
Affiliation:
Harris County Emergency Service District 48 Fire Department, Katy, TexasUSA
Christopher J. Winckler
Affiliation:
Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
*
Julian G. Mapp, MD, MBA, MPH Department of Emergency Health Sciences University of Texas Health Science Center at San AntonioSan Antonio, Texas78229USA E-mail: jmappmd@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs.

Methods:

The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative.

Results:

Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS.

Conclusion:

This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.

Keywords

epidemiologyprehospital transfusionwhole blood
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 98 - 103
Copyright
© World Association for Disaster and Emergency Medicine 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Spinella, PC, Cap, AP. Prehospital hemostatic resuscitation to achieve zero preventable deaths after traumatic injury. Curr Opin Hematol. 2017;24(6):529–535.CrossRefGoogle ScholarPubMed
Bjerkvig, CK, Strandenes, G, Eliassen, HS, et al.“Blood failure” time to view blood as an organ: how oxygen debt contributes to blood failure and its implications for remote damage control resuscitation. Transfusion. 2016;56(Suppl 2):S182–189.CrossRefGoogle ScholarPubMed
White, NJ, Ward, KR, Pati, S, Strandenes, G, Cap, AP. Hemorrhagic blood failure: oxygen debt, coagulopathy, and endothelial damage. J Trauma Acute Care Surg. 2017;82(6S Suppl 1):S41–S49.CrossRefGoogle ScholarPubMed
Woolley, T, Thompson, P, Kirkman, E, et al.Trauma Hemostasis and Oxygenation Research Network position paper on the role of hypotensive resuscitation as part of remote damage control resuscitation. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S3–S13.CrossRefGoogle ScholarPubMed
McGinity, AC, Zhu, CS, Greebon, L, et al.Prehospital low-titer cold-stored whole blood: philosophy for ubiquitous utilization of O-positive product for emergency use in hemorrhage due to injury. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S115–S119.CrossRefGoogle Scholar
Cotton, BA, Dossett, LA, Haut, ER, et al.Multicenter validation of a simplified score to predict massive transfusion in trauma. J Trauma. 2010;69(Suppl 1):S33–39.CrossRefGoogle ScholarPubMed
Nunez, TC, Voskresensky, IV, Dossett, LA, Shinall, R, Dutton, WD, Cotton, BA. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma. 2009;66(2):346–352.CrossRefGoogle ScholarPubMed
Sperry, JL, Guyette, FX, Brown, JB, et al.Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Eng J Med. 2018;379(4):315–326.CrossRefGoogle ScholarPubMed
Moore, HB, Moore, EE, Chapman, MP, et al.Plasma-first resuscitation to treat hemorrhagic shock during emergency ground transportation in an urban area: a randomized trial. Lancet. 2018;392(10144):283–291.CrossRefGoogle Scholar
Eastridge, BJ, Salinas, J, Wade, CE, Blackbourne, LH. Hypotension is 100 mm Hg on the battlefield. Am J Surg. 2011;202(4):404–408.CrossRefGoogle ScholarPubMed
Oyetunji, TA, Chang, DC, Crompton, JG, et al.Redefining hypotension in the elderly: normotension is not reassuring. Arch Surg. 2011;146(7):865–869.CrossRefGoogle Scholar
Hasler, RM, Nuesch, E, Juni, P, Bouamra, O, Exadaktylos, AK, Lecky, F. Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: multicenter cohort study. Resuscitation. 2012;83(4):476–481.CrossRefGoogle Scholar
Hasler, RM, Nuesch, E, Juni, P, Bouamra, O, Exadaktylos, AK, Lecky, F. Systolic blood pressure below 110 mm Hg is associated with increased mortality in blunt major trauma patients: multicenter cohort study. Resuscitation. 2011;82(9):1202–1207.CrossRefGoogle Scholar
Eastridge, BJ, Salinas, J, McManus, JG, et al.Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63(2):291–297; discussion 297-299.CrossRefGoogle ScholarPubMed
Shibutani, K, Muraoka, M, Shirasaki, S, Kubal, K, Sanchala, VT, Gupte, P. Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output? Anesth Analg. 1994;79(5):829–833.CrossRefGoogle ScholarPubMed
West, JB. State of the art: ventilation-perfusion relationships. Am Rev Respir Dis. 1977;116(5):919–943.Google ScholarPubMed
Trillo, G, von Planta, M, Kette, F. ETCO2 monitoring during low flow states: clinical aims and limits. Resuscitation. 1994;27(1):1–8.CrossRefGoogle ScholarPubMed
Williams, DJ, Guirgis, FW, Morrissey, TK, et al.End-tidal carbon dioxide and occult injury in trauma patients: ETCO2 does not rule out severe injury. Am J Emerg Med. 2016;34(11):2146–2149.CrossRefGoogle Scholar
Dunham, CM, Chirichella, TJ, Gruber, BS, et al.In emergently ventilated trauma patients, low end-tidal CO2 and low cardiac output are associated and correlate with hemodynamic instability, hemorrhage, abnormal pupils, and death. BMC Anesthesiol. 2013;13(1):20.CrossRefGoogle ScholarPubMed
Caputo, ND, Fraser, RM, Paliga, A, et al.Nasal cannula end-tidal CO2 correlates with serum lactate levels and odds of operative intervention in penetrating trauma patients: a prospective cohort study. J Trauma Acute Care Surg. 2012;73(5):1202–1207.CrossRefGoogle ScholarPubMed
Tyburski, JG, Carlin, AM, Harvey, EH, Steffes, C, Wilson, RF. End-tidal CO2-arterial CO2 differences: a useful intraoperative mortality marker in trauma surgery. J Trauma. 2003;55(5):892–896; discussion 896-897.CrossRefGoogle ScholarPubMed
Tyburski, JG, Collinge, JD, Wilson, RF, Carlin, AM, Albaran, RG, Steffes, CP. End-tidal CO2-derived values during emergency trauma surgery correlated with outcome: a prospective study. J Trauma. 2002;53(4):738–743.CrossRefGoogle ScholarPubMed
Dudaryk, R, Bodzin, DK, Ray, JJ, Jabaley, CS, McNeer, RR, Epstein, RH. Low end-tidal carbon dioxide at the onset of emergent trauma surgery is associated with non-survival: a case series. Anesth Analg. 2017;125(4):1261–1266.CrossRefGoogle Scholar
Stone, ME Jr., Kalata, S, Liveris, A, et al.End-tidal CO2 on admission is associated with hemorrhagic shock and predicts the need for massive transfusion as defined by the critical administration threshold: a pilot study. Injury. 2017;48(1):51–57.CrossRefGoogle ScholarPubMed
Childress, K, Arnold, K, Hunter, C, Ralls, G, Papa, L, Silvestri, S. Prehospital end-tidal carbon dioxide predicts mortality in trauma patients. Prehosp Emerg Care. 2018;22(2):170–174.CrossRefGoogle ScholarPubMed
Deakin, CD, Sado, DM, Coats, TJ, Davies, G. Prehospital end-tidal carbon dioxide concentration and outcome in major trauma. J Trauma. 2004;57(1):65–68.CrossRefGoogle ScholarPubMed
Shackelford, SA, Del Junco, DJ, Powell-Dunford, N, et al.Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318(16):1581–1591.CrossRefGoogle ScholarPubMed
Valenzuela, TD, Roe, DJ, Nichol, G, Clark, LL, Spaite, DW, Hardman, RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000;343(17):1206–1209.CrossRefGoogle ScholarPubMed