Use of prothrombin complex concentrates: 4-year experience of a national aeromedical retrieval service servicing remote and rural areas.
BACKGROUND
Prothrombin complex concentrates (PCCs) are recommended as first-line treatment for acquired or congenital factor II, VII, IX and X deficiencies in situations of major haemorrhage. The Emergency Medical Retrieval Service (EMRS) provides critical care and aeromedical retrieval to patients in remote and rural Scotland. It has an important role in the care of these patients.


METHODS
We sought to determine the incidence of haemorrhage requiring PCC administration in our cohort of patients, and to assess compliance with current national guidelines regarding their storage and use. We searched our database for all patients that received PCCs, or met current guidelines for their administration, and followed them through to hospital discharge. We also conducted a telephone survey of all hospitals served by the EMRS to determine compliance with national standards.


RESULTS
During the 42-month study period, 1170 retrieval missions were conducted. Twenty-six retrieved patients had a congenital or acquired clotting factor deficiency and seven met criteria for PCC administration. Of these, only three received PCCs prior to transfer to definitive care. Telephone survey revealed that all the rural general hospitals were served by the EMRS stock PCCs, but only one out of 15 GP-led community hospitals had access to PCCs.


CONCLUSIONS
In the remote and rural setting where access to definitive care may be limited or delayed, timely administration of PCCs in appropriate patients may improve outcomes. As many rural hospitals do not have access to PCCs, the ability of the EMRS to provide this treatment may improve patient care.
Emergency Medical Retrieval Service, Bond Air Services, Glasgow, UK.
Laura Catriona
LC
Robertson
Jayne A C
JA
McKinlay
Philip T
PT
Munro
Stephen
S
Hearns
D017732:Air Ambulances; D001778:Blood Coagulation Disorders / Q000150:complications / Q000188:drug therapy*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019035:Rural Health Services; D012606:Scotland
D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates
Trauma, head; critical care transport; emergency care systems, remote and rural medicine; prehospital care; remote and rural medicine