Prehospital Transfusion for Gastrointestinal Bleeding

Maile E. Parker, Mohammad A. Khasawneh, Cornelius A. Thiels, Kathleen S. Berns, James R. Stubbs, Donald H. Jenkins, Scott P. Zietlow, Martin D. Zielinski

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Gastrointestinal (GI) bleeding is a common medical emergency with significant morbidity and mortality. Many patients are coagulopathic, which may perpetuate bleeding. Remote damage control resuscitation, including early correction of coagulopathy and anemia, may benefit exsanguinating patients with GI bleeding. Methods: We conducted a retrospective review of patients with acute GI bleeding who received packed red blood cells (pRBC) and/or plasma during transportation to our institution between 2010 and 2014. A comparison group of patients who were not transfused en route was selected, and demographics, outcomes, and response to resuscitation were compared. Results: A total of 112 patients with GI bleeding received pRBC (82%, n = 92 pRBC, mean 1.7 ± 0.9 units), plasma (62%, n = 69, mean 1.7 ± 0.8 units) or both (44%, n = 49) en-route. The comparison group comprised 49 patients transported by helicopter who were not transfused en-route. Demographics, crystalloid resuscitation, transfusion prior to transfer, rate of intervention, ICU days, length of stay, and mortality were similar between groups. Patients transfused en route had a significant increase in hemoglobin from 8.3 ± 2.2 to 8.9 ± 2.1 (P = .03) and decrease in INR from 2.0 ± 1.0 to 1.6 ± 1.4 (P = .01), whereas those not transfused en route experienced stable hemoglobin (8.7 ± 2.8 to 9.4 ± 2.5; P = .21) and INR values (1.9 ± 1.0 to 1.6 ± 1.4; P = .32). Both groups had a significant improvement in hemodynamic parameters with resuscitation. Conclusion: Prehospital damage control resuscitation with pRBC and/or plasma resulted in the improvement of hemodynamic instability, coagulopathy and anemia in patients with acute GI bleeding. Almost all patients required additional inpatient interventions and/or transfusions, suggesting that pre-hospital transfusion is being utilized for appropriately selected patients.

Original languageEnglish (US)
JournalAir Medical Journal
DOIs
StateAccepted/In press - 2017

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Hemorrhage
Resuscitation
Erythrocytes
International Normalized Ratio
Anemia
Hemoglobins
Hemodynamics
Demography
Mortality
Aircraft
Inpatients
Length of Stay
Emergencies
Morbidity

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Parker, M. E., Khasawneh, M. A., Thiels, C. A., Berns, K. S., Stubbs, J. R., Jenkins, D. H., ... Zielinski, M. D. (Accepted/In press). Prehospital Transfusion for Gastrointestinal Bleeding. Air Medical Journal. https://doi.org/10.1016/j.amj.2017.06.002

Prehospital Transfusion for Gastrointestinal Bleeding. / Parker, Maile E.; Khasawneh, Mohammad A.; Thiels, Cornelius A.; Berns, Kathleen S.; Stubbs, James R.; Jenkins, Donald H.; Zietlow, Scott P.; Zielinski, Martin D.

In: Air Medical Journal, 2017.

Research output: Contribution to journalArticle

Parker, ME, Khasawneh, MA, Thiels, CA, Berns, KS, Stubbs, JR, Jenkins, DH, Zietlow, SP & Zielinski, MD 2017, 'Prehospital Transfusion for Gastrointestinal Bleeding', Air Medical Journal. https://doi.org/10.1016/j.amj.2017.06.002
Parker ME, Khasawneh MA, Thiels CA, Berns KS, Stubbs JR, Jenkins DH et al. Prehospital Transfusion for Gastrointestinal Bleeding. Air Medical Journal. 2017. https://doi.org/10.1016/j.amj.2017.06.002
Parker, Maile E. ; Khasawneh, Mohammad A. ; Thiels, Cornelius A. ; Berns, Kathleen S. ; Stubbs, James R. ; Jenkins, Donald H. ; Zietlow, Scott P. ; Zielinski, Martin D. / Prehospital Transfusion for Gastrointestinal Bleeding. In: Air Medical Journal. 2017.
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