title: Prehospital Blood Product Resuscitation for Trauma: A Systematic Review.
abstract: Administration of high ratios of plasma to packed red blood cells is a routine practice for in-hospital trauma resuscitation. Military and civilian emergency teams are increasingly carrying prehospital blood products (PHBP) for trauma resuscitation. This study systematically reviewed the clinical literature to determine the extent to which the available evidence supports this practice.
  
  
  
  Bibliographic databases and other sources were searched to July 2015 using keywords and index terms related to the intervention, setting, and condition. Standard systematic review methodology aimed at minimizing bias was used for study selection, data extraction, and quality assessment (protocol registration
  
  
  
  CRD42014013794). Synthesis was mainly narrative with random effects model meta-analysis limited to mortality outcomes.
  
  
  
  No prospective comparative or randomized studies were identified. Sixteen case series and 11 comparative studies were included in the review. Seven studies included mixed populations of trauma and non-trauma patients. Twenty-five of 27 studies provided only very low quality evidence. No association between PHBP and survival was found (OR for mortality: 1.29, 95% CI: 0.84-1.96, P = 0.24). A single study showed improved survival in the first 24 h. No consistent physiological or biochemical benefit was identified, nor was there evidence of reduced in-hospital transfusion requirements. Transfusion reactions were rare, suggesting the short-term safety of PHBP administration.
  
  
  
  While PHBP resuscitation appears logical, the clinical literature is limited, provides only poor quality evidence, and does not demonstrate improved outcomes. No conclusions as to efficacy can be drawn. The results of randomized controlled trials are awaited.
authors.affiliation: *NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham †Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Edgbaston, Birmingham ‡205 (Scottish) Field Hospital, Govan, Glasgow §Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, ICT Centre, Edgbaston, Birmingham ||East Anglian Air Ambulance, Gambling Close, Norwich ¶Ministry of Defence Hospital Unit Derriford, Derriford Hospital, Plymouth, United Kingdom **Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Iain M
authors.initials: IM
authors.lastname: Smith
authors.forename: Robert H
authors.initials: RH
authors.lastname: James
authors.forename: Janine
authors.initials: J
authors.lastname: Dretzke
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Midwinter
mesh_terms: D016913:Blood Component Transfusion / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation / Q000379:methods*; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy
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