Leucocyte depleted red cells and plasma transfusion
An evaluation of leucocyte depleted red cells and plasma transfusion for major traumatic haemorrhage in patients presenting to the prehospital setting in London - feasibility study
Background
Approximately 100 people each year in London suffer traumatic injuries that resulting in blood loss that could result in death before they reach hospital. In 2012 London's Air Ambulance was the first in the UK to treat these patients with pre-hospital transfusions of red blood cells. As a result, pre-hospital mortality for this severely bleeding group reduced from 34% to 19%.
The study
In October 2018 London's Air Ambulance introduced a new blood component that contains red blood cells and plasma in a single unit (Red Cell & Plasma) as part of the 2 year feasibility study. This new blood component improves upon current treatment by adding plasma to the transfusion bag. This helps to form stronger blood clots, and also reduces the time to receiving effective therapy for people with severe blood loss, thus significantly improving their chances of survival.
The strength of the study is the collaboration between three organisations - C4TS (Queen Mary University of London), NHS Blood and Transplant and Barts Health Trust. The organisations funding the study are Barts Charity, London Air Ambulance, Saracens Rugby Club and The Henry Surtees Foundation.
The new study assessed patient outcomes by comparing the current blood product against the new blood product, and will also compare transfusion data from Kent Surrey & Sussex Air Ambulance, Thames Valley Air Ambulance, the Great North Air Ambulance Service and Essex and Hertfordshire Air Ambulance.
Download the study protocol here
Final Outcomes
The Red Cell and Plasma study completed in October 2020
Study Outcomes
Tucker, H., Brohi, K., Tan, J. et al. Association of red blood cells and plasma transfusion versus red blood cell transfusion only with survival for treatment of major traumatic hemorrhage in prehospital setting in England: a multicenter study. Crit Care 27, 25 (2023). https://doi.org/10.1186/s13054-022-04279-4
Results
Out of 970 recruited patients, 909 fulfilled the study criteria (RBC + P = 391, RCP = 295, RBC = 223). RBC + P patients were older (mean age 42 vs 35 years for RCP and RBC), and 80% had a blunt injury (RCP = 52%, RBC = 56%). RCP and RBC + P were associated with lower odds of death at 24-h, compared to RBC alone (adjusted odds ratio [aOR] 0.69 [95%CI: 0.52; 0.92] and 0.60 [95%CI: 0.32; 1.13], respectively). The lower odds of death for RBC + P and RCP vs RBC were driven by penetrating injury (aOR 0.22 [95%CI: 0.10; 0.53] and 0.39 [95%CI: 0.20; 0.76], respectively). There was no association between RCP or RBC + P with 30-day survival vs RBC.
Conclusion
Prehospital plasma transfusion for penetrating injury was associated with lower odds of death at 24-h compared to RBC alone. Large trials are needed to confirm these findings.
More importantly, this study led to the development of the randomised control trial (I am the CI) called SWiFT trial – link below
https://www.nhsbt.nhs.uk/clinical-trials-unit/current-trials-and-studies/swift/
Trial protocol link
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-023-07711-4
Dr Laura Green, Consultant Haematologist at NHSBT and Barts Health Trust and Senior Lecturer in Trauma Sciences at QMUL
Dr Anne Waver, Consultant in Pre-Hospital Care at London's Air Ambulance and Clinical Director of Trauma at The Royal London Hospital, Barts Health NHS Trust
Dr Ross Davenport, Senior Lecturer in Trauma Sciences at QMUL and Consultant Trauma and Vascular Surgeon at Barts Health NHS Trust.
