Abstract - Text

Offenlegung Interessenkonflikt:

no conflict of interest

Methods

The CredoMed® (BioThermal™) box was used for transport of 3 pRBCs and 3 tFFPs with HEMS. Before use, cooling tiles (ct) of the box were stored 8h at <-18°C, subsequently 12h at 4°C. Temperature monitoring was performed by loggers. Quality parameters for pRBCs: Hct, Hb, hemolysis rate (HR), potassium concentration; for tFFPs: PT, aPTT, single clotting factor (cf) activities (cfI-XIII; vWF; proteins C, S). Parameters were assessed 1. before/24h after 1-day routine HEMS operation (12 pRBCs, 12 tFFPs); 2. before/after 3-days routine HEMS operation (one rest day after each flight day (blood bank,4°C: reactivation of ct; 3 pRBCs, 3 tFFPs). For 3-day evaluation blood components were split: one bag transported by HEMS, one bag stored in blood bank.

Results

Temperature of 4±2°C was maintained in the box for at least 36h. After 1-day (median flight time (ft) 231min/d; range 172 – 255min/d) and 3-day transport evaluation (cumulative ft 521min) pRBC-quality parameters did not leave specification (HR did not increase, potassium levels <60mmol/l). In tFFPs most pronounced decrease in cf activity was observed for cf VIII (after 1-day flight -13% (mean, range -25% - 3%) and -37% after 3-day-evaluation (mean, range final levels -36.1- -56.7%). Other cf decreased by <5% after 1-day flight and <10% after 3-day flight, except protein S (mean -24%, final levels 55-103%) and cf XI (mean -11.3%, final levels 89-101%). There was no difference in decrease of cf activities in HEMS and blood bank tFFP-bags.

Background

Transfusion of packed red blood cell (pRBCs) and thawed fresh frozen plasma (tFFP) in a ratio 1:1 as early as possible is recommended to improve the outcome of trauma patients. Supply of pRBCs and tFFPs for the regional Helicopter Emergency Services (HEMS) facilitates prehospital blood transfusion.

Conclusion

The CredoMed® box is an appropriate system for 24-hour storage of blood products on the helicopter. Helicopter transport does not alter quality of RBC concentrates or tFFP in comparison to the same products stored in the blood bank. This system enables prehospital hemotherapy in trauma patients.