Cold-stored whole blood in a Norwegian emergency helicopter service: an observational study on storage conditions and product quality.
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
30
10
2019
revised:
16
02
2020
accepted:
26
02
2020
pubmed:
23
4
2020
medline:
23
6
2021
entrez:
23
4
2020
Statut:
ppublish
Résumé
Increasing numbers of emergency medical service agencies and hospitals are developing the capability to administer blood products to patients with hemorrhagic shock. Cold-stored whole blood (WB) is the only single product available to prehospital providers who aim to deliver a balanced resuscitation strategy. However, there are no data on the safety and in vitro characteristics of prehospital stored WB. This study aimed to describe the effects on in vitro quality of storing WB at remote helicopter bases in thermal insulating containers. We conducted a two-armed single-center study. Twenty units (test) were stored in airtight thermal insulating containers, and 20 units (controls) were stored according to routine procedures in the Haukeland University Hospital Blood Bank. Storage conditions were continuously monitored during emergency medical services missions and throughout remote and blood bank storage. Hematologic and metabolic variables, viscoelastic properties, and platelet (PLT) aggregation were measured on Days 1, 8, 14, and 21. Storage conditions complied with the EU guidelines throughout remote and in-hospital storage for 21 days. There were no significant differences in PLT aggregation, viscoelastic properties, and hematology variables between the two groups. Minor significantly lower pH, glucose, and base excess and higher lactate were observed after storage in airtight containers. Forward cold storage of WB is safe and complies with EU standards. No difference is observed in hemostatic properties. Minor differences in metabolic variables may be related to the anaerobic conditions within the thermal box.
Sections du résumé
BACKGROUND
Increasing numbers of emergency medical service agencies and hospitals are developing the capability to administer blood products to patients with hemorrhagic shock. Cold-stored whole blood (WB) is the only single product available to prehospital providers who aim to deliver a balanced resuscitation strategy. However, there are no data on the safety and in vitro characteristics of prehospital stored WB. This study aimed to describe the effects on in vitro quality of storing WB at remote helicopter bases in thermal insulating containers.
STUDY DESIGN AND METHODS
We conducted a two-armed single-center study. Twenty units (test) were stored in airtight thermal insulating containers, and 20 units (controls) were stored according to routine procedures in the Haukeland University Hospital Blood Bank. Storage conditions were continuously monitored during emergency medical services missions and throughout remote and blood bank storage. Hematologic and metabolic variables, viscoelastic properties, and platelet (PLT) aggregation were measured on Days 1, 8, 14, and 21.
RESULTS
Storage conditions complied with the EU guidelines throughout remote and in-hospital storage for 21 days. There were no significant differences in PLT aggregation, viscoelastic properties, and hematology variables between the two groups. Minor significantly lower pH, glucose, and base excess and higher lactate were observed after storage in airtight containers.
CONCLUSION
Forward cold storage of WB is safe and complies with EU standards. No difference is observed in hemostatic properties. Minor differences in metabolic variables may be related to the anaerobic conditions within the thermal box.
Substances chimiques
Blood Glucose
0
Types de publication
Clinical Trial
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1544-1551Subventions
Organisme : Laboratory Medicine and Pathology, Haukeland University Hospital, Bergen, Norway
Organisme : Norwegian Armed Forces Joint Medical Services
Informations de copyright
© 2020 The Authors. Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.
Références
Yazer MH, Spinella PC. The use of low-titer group O whole blood for the resuscitation of civilian trauma patients in 2018. Transfusion 2018;58:2744-6.
Curry NS, Davenport R. Transfusion strategies for major haemorrhage in trauma. Br J Haematol 2019;184:508-23.
Cap AP, Pidcoke HF, Spinella P, et al. Damage control resuscitation. Mil Med 2018;183:36-43.
Holcomb JB. Damage control resuscitation. J Trauma 2007;62:S36-7.
Cantle PM, Cotton BA. Balanced resuscitation in trauma management. Surg Clin North Am 2017;97:999-1014.
Eckel AM, Hess JR. Transfusion practice in trauma resuscitation. South Med J 2017;110:554-8.
Spinella PC, Cap AP. Prehospital hemostatic resuscitation to achieve zero preventable deaths after traumatic injury. Curr Opin Hematol 2017;24:529-35.
Krook C, OʼDochartaigh D, Martin D, et al. Blood on board: the development of a prehospital blood transfusion program in a Canadian helicopter emergency medical service. CJEM 2019;21:365-73.
Yazer MH, Spinella PC, Allard S, et al. Vox Sanguinis International Forum on the use of prehospital blood products and pharmaceuticals in the treatment of patients with traumatic haemorrhage. Vox Sang 2018;113:701-6.
Bjerkvig CK, Strandenes G, Eliassen HS, et al. "Blood failure" time to view blood as an organ: how oxygen debt contributes to blood failure and its implications for remote damage control resuscitation. Transfusion 2016;56(Suppl 2):S182-9.
Spinella PC, Reddy HL, Jaffe JS, et al. Fresh whole blood use for hemorrhagic shock: preserving benefit while avoiding complications. Anesth Analg 2012;115:751-8.
Cordova CB, Capp AP, Spinella PC. Fresh whole blood transfusion for a combat casualty in austere combat environment. J Spec Oper Med 2014;14:9-12.
Strandenes G, Berseus O, Cap AP, et al. Low titer group O whole blood in emergency situations. Shock 2014;41(Suppl 1):70-5.
Strandenes G, Hervig TA, Bjerkvig CK, et al. The lost art of whole blood transfusion in austere environments. Curr Sports Med Rep 2015;14:129-34.
Fisher AD, Washbum G, Powell D, et al. Damage control resuscitation in prolonged field caredamage control resuscitation in prolonged field care. J Spec Oper Med 2018;18:109-19.
Belin TR, Yazer MH, Meledeo MA, et al. An evaluation of methods for producing low-titer group O whole blood to support military trauma resuscitation. J Trauma Acute Care Surg 2017;82:S79-86.
Strandenes G, De Pasquale M, Cap AP, et al. Emergency whole blood use in the field: a simplified protocol for collection and transfusion. Shock 2014;41(Suppl 1):76-83.
Karl A, Pham T, Yanosky JD, et al. Variability of uncrossmatched blood use by helicopter EMS programs in the United States. Prehosp Emerg Care 2016;20:688-94.
Guide to the preparation, use and quality assurance of blood components [Internet]. Strasbourg: EQDM Council of Europe; 2017 [cited 2019 Aug 18]. Available from: https://www.edqm.eu/en/blood-transfusion-guide.
Cattaneo M, Cerletti C, Harrison P, et al. Recommendations for the standardization of light transmission aggregometry: a consensus of the working party from the Platelet Physiology Subcommittee of SSC/ISTH. J Thromb Haemost 2013;11:1183-9.
Brunskill S, Thomas S, Whitmore E, et al. What is the maximum time that a unit of red blood cells can be safely left out of controlled temperature storage? Transfus Med Rev 2012;26:209-23 e3.
Nilsson L, Hedner U, Nilsson IM, et al. Shelf-life of bank blood and stored plasma with special reference to coagulation factors. Transfusion 1983;23:377-81.
Blaine KP, Cortes-Puch I, Sun J, et al. Impact of different standard red blood cell storage temperatures on human and canine RBC hemolysis and chromium survival. Transfusion 2019;59:347-58.
Aalaei S, Amini S, Keramati MR, et al. Blood bag temperature monitoring system. Stud Health Technol Inform 2014;205:730-4.
Bochsen L, Wiinberg B, Kjelgaard-Hansen M, et al. Evaluation of the TEG platelet mapping assay in blood donors. Thromb J 2007;5:3.
Strandenes G, Austlid I, Apelseth TO, et al. Coagulation function of stored whole blood is preserved for 14 days in austere conditions: a ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood. J Trauma Acute Care Surg 2015;78:S31-8.
Pidcoke HF, McFaul SJ, Ramasubramanian AK, et al. Primary hemostatic capacity of whole blood: a comprehensive analysis of pathogen reduction and refrigeration effects over time. Transfusion 2013;53(Suppl 1):137S-49S.
Meledeo MA, Peltier GC, McIntosh CS, et al. Optimizing whole blood storage: hemostatic function of 35-day stored product in CPD, CP2D, and CPDA-1 anticoagulants. Transfusion 2019;59:1549-59.