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    06 Weaver RDCR Laa Transfusion Aew43

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    Anonymous ONp8r5Dk
    This document discusses pre-hospital blood transfusions and the "Blood on Board" program launched in the UK. It provides statistics on traumatic hemorrhage deaths and reviews the development of the CODE RED protocol at the Royal London Hospital in 2008, which allowed pre-hospital transfusions. Data is presented from over 1000 missions since 2012 showing improved survival to hospital emergency department with pre-hospital transfusions. Next steps discussed include enhanced safety, additional blood product availability, and improving in-hospital processes and mass casualty planning.

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    06 Weaver RDCR Laa Transfusion Aew43

    Uploaded by

    Anonymous ONp8r5Dk
    34 views43 pages
    This document discusses pre-hospital blood transfusions and the "Blood on Board" program launched in the UK. It provides statistics on traumatic hemorrhage deaths and reviews the development of the CODE RED protocol at the Royal London Hospital in 2008, which allowed pre-hospital transfusions. Data is presented from over 1000 missions since 2012 showing improved survival to hospital emergency department with pre-hospital transfusions. Next steps discussed include enhanced safety, additional blood product availability, and improving in-hospital processes and mass casualty planning.

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    06 Weaver Rdcr Laa Transfusion Aew43

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    This document discusses pre-hospital blood transfusions and the "Blood on Board" program launched in the UK. It provides statistics on traumatic hemorrhage deaths and reviews the development of the CODE RED protocol at the Royal London Hospital in 2008, which allowed pre-hospital transfusions. Data is presented from over 1000 missions since 2012 showing improved survival to hospital emergency department with pre-hospital transfusions. Next steps discussed include enhanced safety, additional blood product availability, and improving in-hospital processes and mass casualty planning.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views43 pages

    06 Weaver RDCR Laa Transfusion Aew43

    Uploaded by

    Anonymous ONp8r5Dk
    This document discusses pre-hospital blood transfusions and the "Blood on Board" program launched in the UK. It provides statistics on traumatic hemorrhage deaths and reviews the development of the CODE RED protocol at the Royal London Hospital in 2008, which allowed pre-hospital transfusions. Data is presented from over 1000 missions since 2012 showing improved survival to hospital emergency department with pre-hospital transfusions. Next steps discussed include enhanced safety, additional blood product availability, and improving in-hospital processes and mass casualty planning.

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    You are on page 1of 43

    Update

    on pre-hospital blood
    transfusions

    Dr Anne Weaver
    Consultant in Emergency Medicine & Pre-hospital
    Care
    RDCR 2016

    ObjecGves

    •  How and why “Blood on board” was launched


    •  Share our results
    •  Next steps
    And will conGnue your efforts……
    UK stats – trauma haemorrhage

    •  4700 / yr major haemorrhage (1550 dead)
    •  1300 / yr massive haemorrhage (585 dead)
    •  Deaths 50% in 24hrs (50% in first 4 hrs)
    •  50% needed urgent surgery
    •  £85 million / yr
    Vicky
    Video / imaginaGon
    •  Look
    •  Colour
    •  Limb posiGon
    •  Eyes – no drugs
    •  Why is she dying?
    •  What intervenGons does she need?
    •  What fluid would you give her?
    Crystalloid
    •  Every UK ambulance
    •  Cheap
    •  “safe”

    •  Useful for most pts…
    but they are not
    bleeding
    •  How much will Vicky
    need to resuscitate her?
    Why would you give her crystalloid?
    •  Doesn’t stay in vascular space
    •  3 Gmes volume for effect
    •  No oxygen carrying capacity
    •  Increases Gssue oedema
    •  Increases acidosis
    •  Old debate. Over it!

    •  Only if you have no other opGon…..


    Vicky needs
    •  Team to idenGfy shock
    •  Make a diagnosis
    •  Deliver excellent basic care
    •  Provide appropriate advanced intervenGons
    •  Make a risk-benefit analysis about whether to
    give blood

    Catastrophic haemorrhage in PHC

    •  C ABC
    •  Tourniquets
    •  Novel haemostaGc agents - celox
    •  Handling and packaging
    •  Splintage
    •  Permissive hypotension
    •  Damage control resuscitaGon
    Catastrophic haemorrhage in PHC
    •  RecogniGon of serious haemorrhage
    •  AcGvate massive haemorrhage protocols
    •  Pre-hospital transfusion
    •  Emergency reversal of warfarin at scene / en
    route
    •  Awareness of novel oral anG-coagulants
    •  Aggressive vascular control in the field
    Vicky needs a fluid that

    •  Carries oxygen to repay oxygen debt


    •  Contributes to haemostaGc resuscitaGon
    •  Stays in the intravascular space

    •  There are risks with blood transfusion but her


    predicted mortality exceeds 50%

    2007 - how did it all start?
    •  Serious incidents at RLH
    •  Interested group of people
    •  Development of Code Red protocol
    •  Increasing frustraGon / awareness of potenGal
    to do more
    •  Watching paGents die
    Pelvic injury
    Time to definiGve care…..
    CODE RED @ RLH 2008
    1:1
    CODE RED PROTOCOL

    Pre-alert from HEMS team


    Average age 34 yrs
    Mortality 49%
    Replicated across other London MTCs
    2011 – TXA for Code Red only
    March 2012 – Blood on Board
    Equipment
    SOP – indicaGons for PH transfusion

    •  CODE RED in extremis


    or
    •  TraumaGc arrest where hypovolaemia is
    considered to be a contribuGng factor

    •  (Compensatory Reserve Index = RED?)


    >1000
    missions

    50 pre-
    hospital
    transfusions

    22 trauma;c
    28 Code Red
    cardiac
    in extremis
    arrests

    11 PLE on 1 infant in
    10 ROSC
    scene arrest to ED
    39 PH Txn
    to ED

    24 8 died in 3 died in 4 died on


    survived ED OR ICU
    Mean age
    80% male
    35yrs

    45% ROSC
    from TCA
    2.8 units PRBC On-scene ;me
    transfused 37 mins

    Hb 14.0 pH 7.07

    BE – 12.8
    First 6 months data
    10.5u PRBC in 8.3u FFP in 24
    24hrs hrs

    141 units PRBC


    100%
    transfused on-
    traceability
    scene

    1 unit PRBC
    wasted
    18 months data
    Our results
    •  Feasible pracGce and low waste
    •  Associated with increased survival to ED
    •  PotenGal improved organ donaGon rates
    •  Will not demonstrate lactate clearance or
    increased survival to discharge
    •  Not a trial powered to prove anything
    •  Needed blood product pre-hospital
    –  support our advanced pracGce
    –  Replicate hospital care
    Pre-hospital blood trials
    •  PRBC
    •  Improved outcomes – not always stat sig
    •  6hr survival
    •  24hr survival
    •  Reduced blood product transfusion in 24hrs
    •  Improved BE / acid base balance on admission
    •  Feasible
    •  Low waste
    InnovaGon has a naGonal impact
    •  AssociaGon of Air Ambulances
    •  UK HEMS
    •  Kent, Surrey and Sussex Air Ambulance
    •  Thames Valley AA
    •  EMRS – Scotland
    •  GNAAS - Tyneside
    •  GWAAS / Wiltshire
    •  Welsh EMRT
    Next steps for LAA blood project
    •  Enhanced safety / logisGcs – tracking
    systems / data collecGon
    •  AddiGonal product availability for HEMS
    –  Whole blood, liquid plasma, fibrinogen
    •  Thawed plasma in resus at RLH
    •  Improve in-hospital processes
    •  Mass casualty planning
    Vicky
    ROYAL LONDON HOSPITAL MTC CODE RED MORTALITY

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