Warren and colleagues examined 25,473 trauma patients transported by EMS and retrospectively applied proposed prehospital blood transfusion criteria based on severe hypotension, hypotension with tachycardia, or EMS-witnessed traumatic arrest.
Among 905 patients meeting at least one criterion, 475 (52%) received blood within four hours of hospital arrival. The best-performing criterion, systolic blood pressure below 90 mmHg combined with heart rate of at least 110 beats per minute, reached a positive predictive value of 56%.
The problem is patient selection.The need for emergent transfusion is clinically important, but simple prehospital physiological criteria still identify it with limited precision.
The authors conclude that these findings may help further optimize prehospital blood transfusion criteria and identify patients most likely to benefit.
The Open Discussion page presents a separate research and protocol-development hypothesis. This study did not evaluate BHOC/HBOC therapy and did not directly measure tissue oxygenation as a patient-selection criterion.