Multicenter Observational Prehospital Resuscitation on Helicopter Study (PROHS)

the PROHS Study Group

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: Earlier use of in-hospital plasma, platelets and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. METHODS: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from Jan–Nov 2015. Five helicopter systems had plasma and/or RBCs while the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high risk criteria were analyzed. Patients receiving PHT were compared to patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. RESULTS: 25,118 trauma patients were admitted, 2341 (9%) were transported by helicopter, of which 1058 (45%) met the highest risk criteria. 585/1058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and GCS (7 vs 14) was significantly lower, while median ISS was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 (8.4% vs 3.6%), 24 (12.6% vs 8.9%) hours and 30 days (19.3% vs 13.3%). 24% of eligible patients received a prehospital transfusion. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs and 69% received both. In the propensity score matching analysis (n=109), PHT was not significantly associated with mortality at any time point, although only 10% of the high risk sample were able to be matched. CONCLUSIONS: Because of the unexpected imbalance in systolic blood pressure, GCS and ISS between systems with and without blood products on helicopters, matching was limited and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population. LEVEL OF EVIDENCE:: 2

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Apr 5 2017

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Aircraft
Resuscitation
Erythrocytes
Blood Pressure
Propensity Score
Survival
Wounds and Injuries
Mortality
Trauma Centers
Blood Transfusion
Multicenter Studies
Blood Platelets
Retrospective Studies
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Multicenter Observational Prehospital Resuscitation on Helicopter Study (PROHS). / the PROHS Study Group.

In: Journal of Trauma and Acute Care Surgery, 05.04.2017.

Research output: Contribution to journalArticle

@article{dea29d3a249c484e8b69829581164ffe,
title = "Multicenter Observational Prehospital Resuscitation on Helicopter Study (PROHS)",
abstract = "BACKGROUND: Earlier use of in-hospital plasma, platelets and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. METHODS: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from Jan–Nov 2015. Five helicopter systems had plasma and/or RBCs while the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high risk criteria were analyzed. Patients receiving PHT were compared to patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. RESULTS: 25,118 trauma patients were admitted, 2341 (9{\%}) were transported by helicopter, of which 1058 (45{\%}) met the highest risk criteria. 585/1058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and GCS (7 vs 14) was significantly lower, while median ISS was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 (8.4{\%} vs 3.6{\%}), 24 (12.6{\%} vs 8.9{\%}) hours and 30 days (19.3{\%} vs 13.3{\%}). 24{\%} of eligible patients received a prehospital transfusion. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24{\%} received only plasma, 7{\%} received only RBCs and 69{\%} received both. In the propensity score matching analysis (n=109), PHT was not significantly associated with mortality at any time point, although only 10{\%} of the high risk sample were able to be matched. CONCLUSIONS: Because of the unexpected imbalance in systolic blood pressure, GCS and ISS between systems with and without blood products on helicopters, matching was limited and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population. LEVEL OF EVIDENCE:: 2",
author = "{the PROHS Study Group} and Holcomb, {John B.} and Swartz, {Michael D.} and DeSantis, {Stacia M.} and Greene, {Thomas J.} and Fox, {Erin E.} and Stein, {Deborah M.} and Bulger, {Eileen M.} and Kerby, {Jeffrey D.} and Michael Goodman and Schreiber, {Martin A.} and Zielinski, {Martin D.} and Okeeffe, {Terence S} and Kenji Inaba and Tomasek, {Jeffrey S.} and Podbielski, {Jeanette M.M.} and Savitri Appana and Misung Yi and Wade, {Charles E.}",
year = "2017",
month = "4",
day = "5",
doi = "10.1097/TA.0000000000001484",
language = "English (US)",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",

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TY - JOUR

T1 - Multicenter Observational Prehospital Resuscitation on Helicopter Study (PROHS)

AU - the PROHS Study Group

AU - Holcomb, John B.

AU - Swartz, Michael D.

AU - DeSantis, Stacia M.

AU - Greene, Thomas J.

AU - Fox, Erin E.

AU - Stein, Deborah M.

AU - Bulger, Eileen M.

AU - Kerby, Jeffrey D.

AU - Goodman, Michael

AU - Schreiber, Martin A.

AU - Zielinski, Martin D.

AU - Okeeffe, Terence S

AU - Inaba, Kenji

AU - Tomasek, Jeffrey S.

AU - Podbielski, Jeanette M.M.

AU - Appana, Savitri

AU - Yi, Misung

AU - Wade, Charles E.

PY - 2017/4/5

Y1 - 2017/4/5

N2 - BACKGROUND: Earlier use of in-hospital plasma, platelets and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. METHODS: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from Jan–Nov 2015. Five helicopter systems had plasma and/or RBCs while the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high risk criteria were analyzed. Patients receiving PHT were compared to patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. RESULTS: 25,118 trauma patients were admitted, 2341 (9%) were transported by helicopter, of which 1058 (45%) met the highest risk criteria. 585/1058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and GCS (7 vs 14) was significantly lower, while median ISS was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 (8.4% vs 3.6%), 24 (12.6% vs 8.9%) hours and 30 days (19.3% vs 13.3%). 24% of eligible patients received a prehospital transfusion. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs and 69% received both. In the propensity score matching analysis (n=109), PHT was not significantly associated with mortality at any time point, although only 10% of the high risk sample were able to be matched. CONCLUSIONS: Because of the unexpected imbalance in systolic blood pressure, GCS and ISS between systems with and without blood products on helicopters, matching was limited and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population. LEVEL OF EVIDENCE:: 2

AB - BACKGROUND: Earlier use of in-hospital plasma, platelets and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. METHODS: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from Jan–Nov 2015. Five helicopter systems had plasma and/or RBCs while the other four helicopter systems used only crystalloid resuscitation. All patients meeting predetermined high risk criteria were analyzed. Patients receiving PHT were compared to patients not receiving PHT. Our primary analysis compared mortality at 3 hours, 24 hours, and 30 days, using logistic regression to adjust for confounders and site heterogeneity to model patients who were matched on propensity scores. RESULTS: 25,118 trauma patients were admitted, 2341 (9%) were transported by helicopter, of which 1058 (45%) met the highest risk criteria. 585/1058 patients were flown on helicopters carrying blood products. In the systems with blood available, prehospital median systolic blood pressure (125 vs 128) and GCS (7 vs 14) was significantly lower, while median ISS was significantly higher (21 vs 14). Unadjusted mortality was significantly higher in the systems with blood products available, at 3 (8.4% vs 3.6%), 24 (12.6% vs 8.9%) hours and 30 days (19.3% vs 13.3%). 24% of eligible patients received a prehospital transfusion. A median of 1 unit of RBCs and plasma were transfused prehospital. Of patients receiving PHT, 24% received only plasma, 7% received only RBCs and 69% received both. In the propensity score matching analysis (n=109), PHT was not significantly associated with mortality at any time point, although only 10% of the high risk sample were able to be matched. CONCLUSIONS: Because of the unexpected imbalance in systolic blood pressure, GCS and ISS between systems with and without blood products on helicopters, matching was limited and the results of this study are inconclusive. With few units transfused to each patient and small outcome differences between groups, it is likely large, multicenter, randomized studies will be required to detect survival differences in this important population. LEVEL OF EVIDENCE:: 2

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DO - 10.1097/TA.0000000000001484

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JO - Journal of Trauma and Acute Care Surgery

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