• Tim W H Rijnhout, Kimberley E Wever, Roy H A R Marinus, Nico Hoogerwerf, GeeraedtsLeo M GLMGJrDepartment of Surgery - section Traumasurgery Amsterdam UMC (previous VUmc), Amsterdam, the Netherlands. Electronic address: l.geeraedts@vumc.nl., and TanEdward C T HECTHDepartment of Surgery - Traumasurgery, Radboud University Medical Center, Nijmegen, the Netherlands and Helicopter Emergency Medical Service Nijmegen lifeliner 3, the Netherlands. Electronic address: Edward.tan@radboudumc.nl..
• Department of Surgery - section Traumasurgery, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: tim.rijnhout@radboudumc.nl.
• Injury. 2019 May 1; 50 (5): 101710271017-1027.

BackgroundLife-threatening haemorrhage accounts for 40% mortality in trauma patients worldwide. After bleeding control is achieved, circulating volume must be restored. Early in-hospital transfusion of blood components is already proven effective, but the scientific proof for the effectiveness of prehospital blood-component transfusion (PHBT) in trauma patients is still unclear.ObjectiveTo systematically review the evidence for effectiveness and safety of PHBT to haemorrhagic trauma patients.MethodsCINAHL, Cochrane, EMBASE, and Pubmed were searched in the period from 1988 until August 1, 2018. Meta-analysis was performed for matched trauma patients receiving PHBT with the primary outcomes 24-hour mortality and long-term mortality. Secondary outcome measure was adverse events as a result of PHBT.ResultsTrauma patients who received PHBT with simultaneous use of packed red blood cells (pRBCs) and plasma showed a statistically significant reduction in long-term mortality (OR = 0.51; 95% CI, 0.36-0.71; P < 0.0001) but no difference in 24-hour mortality (OR = 0.47, 95% CI, 0.17-1.34; P = 0.16). PHBT with individual use of pRBCs showed no difference in long-term mortality (OR = 1.18; 95% CI, 0.93-1.49; P =  0.17) or 24-hour mortality (OR = 0.92; 95% CI, 0.46-1.85; P =  0.82). In a total of 1341 patients who received PHBT, 14 adverse events were reported 1.04%, 95% CI 0.57-1.75%.ConclusionsPHBT with simultaneous use of both pRBCs and plasma resulted in a significant reduction in the odds for long-term mortality. However, based on mainly poor quality evidence no hard conclusion can be drawn about a possible survival benefit for haemorrhagic trauma patients receiving PHBT. Overall, PHBT is safe but results of currently ongoing randomised controlled trials have to be awaited to demonstrate a survival benefit.Study TypeSystematic review and meta-analysis.Copyright © 2019 Elsevier Ltd. All rights reserved.

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