title: Protocol for a systematic review of the clinical effectiveness of pre-hospital blood components compared to other resuscitative fluids in patients with major traumatic haemorrhage.
abstract: BACKGROUND
  There is growing interest in the use of blood components for pre-hospital resuscitation of patients with major traumatic haemorrhage. It has been speculated that early resuscitation with blood components may have benefits in terms of treating trauma-induced coagulopathy, which in turn may influence survival. The proposed systematic review will evaluate the evidence on the clinical effectiveness of pre-hospital blood components (red blood cells and/or plasma or whole blood), in both civilian and military settings, compared with other resuscitation strategies in patients with major traumatic haemorrhage.
  
  
  METHODS
  Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. General medical and specialist databases will be searched; the search strategy will combine terms for the population, intervention and setting. Studies will be selected for review if the population includes adult patients with major traumatic haemorrhage who receive blood components in a pre-hospital setting (civilian or military). Systematic reviews, randomised and non-randomised controlled trials and controlled observational studies will be included. Uncontrolled studies will be considered depending on the volume of controlled evidence. Quality assessment will be tailored to different study designs. Both patient related and surrogate outcomes will be considered. Synthesis is likely to be primarily narrative, but meta-analyses and subgroup analyses will be undertaken where clinical and methodological homogeneity exists.
  
  
  CONCLUSIONS
  Given the increasing use by emergency services of blood components for pre-hospital resuscitation, this is a timely systematic review, which will attempt to clarify the evidence base for this practice. As far as the authors are aware, the proposed systematic review will be the first to address this topic.
  
  
  BACKGROUND
  PROSPERO CRD42014013794.
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK. j.dretzke@bham.ac.uk.
authors.forename: Janine
authors.initials: J
authors.lastname: Dretzke
authors.forename: Iain M
authors.initials: IM
authors.lastname: Smith
authors.forename: Robert H
authors.initials: RH
authors.lastname: James
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Midwinter
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion; D004632:Emergency Medical Services / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D012151:Resuscitation / Q000379:methods*; D000078202:Systematic Reviews as Topic; D014947:Wounds and Injuries / Q000150:complications*