Aggressive Crystalloids
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Dretzke J., Sandercock J., Bayliss S., Burls A. Clinical effectiveness and cost-effectiveness of prehospital IV fluids in trauma patients. Health Technology Assessment 2004; 8:23. Medline
|
|
I
|
Opposes (Red)
|
Survival
|
Patient
|
ED-MD
|
Bickell WH., Wall MJ., Pepe PE., et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. New Eng J Med 1994; 331(17):1105-9. Medline
|
|
I
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-Paramedic
|
Schreiber MA., Meier EN., Tisherman SA., et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: Results of a prospective randomized pilot trial. J Trauma Acute Care Surg 2015; 78(4):687-95; discussion 695-7. Medline
|
|
II
|
Neutral (Yellow)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Dula D., Wood C., Rejmer A., Starr M., Leicht M. Use of prehospital Fluids in Hypotensive Blunt Trauma Patients. Prehospital Emergency Care 2002; 6(4):417-20. Medline
|
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Kaweski SM., Sise MJ., Virgilio RW. The effect of prehospital fluids on survival in trauma patients. J Trauma 1990; 30:1215-9. Medline
|
|
II
|
Neutral (Yellow)
|
Safety
|
Patient
|
PH-Paramedic
|
Leenen M., Scholz A., Lefering R., Flohe S., TraumaRegister DGU . Limited volume resuscitation in hypotensive elderly multiple trauma is safe and prevents early clinical dilutive coagulopathy -- a matched-pair analysis from TraumaRegister DGU((R)). Injury 2014; 45 Suppl 3:S59-63. Medline
|
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Stiell IG., et al. The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ 2008; 178:1141-52. Medline
|
|
II
|
Neutral (Yellow)
|
Pulmonary artery pressure, Central venous pressure
|
Process
|
ED-MD
|
Wu JJ., Huang MS., Tang GJ., Kao WF., Shih HC., Su CH., et al. Hemodynamic response of modified fluid gelatin compared with lactated ringer's solution for volume expansion in emergency resuscitation of hypovolemic shock patients: preliminary report of a prospective, randomized trial. World J Surg 2001; 25(5):598-602. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality and use of PRBCs.
|
Patient
|
ED-Paramedic & MD
|
Zitek T, Ataya R, Farino L, Mohammed S, Miller G. Is the use of greater than 1 L of intravenous crystalloids associated with worse outcomes in trauma patients? Am J Emerg Med 2021; 40:32-6. Medline
|
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-Paramedic
|
Bath MF, Schloer J, Strobel J, et al. Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries. Crit Care. March 2024; 28(1):81. Medline
|
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-Paramedic
|
Brown JB., Cohen MJ., Minei JP., Maier RV., West MA., Billiar TR., et al. Goal-directed resuscitation in the prehospital setting: a propensity-adjusted analysis. J Trauma Acute Care Surg 2013; 74(5):1207-12; discussion 1212-4.
|
|
II
|
Opposes (Red)
|
Survival
|
Patient
|
PH-Paramedic
|
Geeraedts LM Jr, Pothof LA, Caldwell E, de Lange-de Klerk ES, D'Amours SK. Prehospital fluid resuscitation in hypotensive trauma patients: do we need a tailored approach? Injury. 2015 Jan;46(1):4-9. doi: 10.1016/j.injury.2014.08.001. Epub 2014 Aug 11. PMID: 25173671. Medline
|
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
ED-MD
|
Harada MY., Ko A., Barmparas G., et al. 10-year trend in crystalloid resuscitation: Reduced volume and lower mortality. International journal of surgery (London, England). 2017;38:78-82. Medline
|
|
II
|
Opposes (Red)
|
Coagulopathy
|
Patient
|
PH-Paramedic
|
Hubetamann B., Lefering R., Taeger G., Waydhas C., Ruchholtz S., Sven Lendemans and the DGU Trauma Registry. Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry. J Emerg Trauma Shock 2011; 4(4):465-71. Medline
|
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-Paramedic
|
Hussmann B., Heuer M., Lefering R., et al. Prehospital volume therapy as an independent risk factor after trauma. Biomed Res Int 2015; 354367. Medline
|
|
II
|
Opposes (Red)
|
In-hospital mortality
|
Patient
|
In-Patient
|
Jones DG, Nantais J, Rezende-Neto JB, Yazdani S, Vegas P, Rizoli S. Crystalloid resuscitation in trauma patients: deleterious effect of 5L or more in the first 24h. BMC surgery 2018; 18(1):93. Medline
|
|
II
|
Opposes (Red)
|
In-hospital mortality
|
Patient
|
|
Jones DG, Nantais J, Rezende-Neto JB, Yazdani S, Vegas P, Rizoli S. Crystalloid resuscitation in trauma patients: deleterious effect of 5L or more in the first 24h. BMC surgery 2018; 18(1):93. Medline
|
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
ED-MD
|
Ley EJ., Clond MA., Srour MK., et al. Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J Trauma 2011; 70(2):398-400. Medline
|
|
II
|
Opposes (Red)
|
Multi-organ failure rate
|
Patient
|
PH-Paramedic
|
Regel G., Stalp M., Lehmann U., Seekamp A. Prehospital care, importance of early intervention on outcome. Acta Anaesthesiol Scand Suppl 1997; 110:71-6. Medline
|
|
II
|
Opposes (Red)
|
Identification of coagulopathy risk factors
|
Patient
|
|
Wafaisade A., Wutzler S., Lefering R., et al. Drivers of acute coagulopathy after severe trauma: A multivariate analysis of 1987 patients. Emerg Med J 2010; 27(12):934-939. Medline
|
|
II
|
Opposes (Red)
|
Risk of ARDS
|
Patient
|
PH-Paramedic & MD
|
Weykamp MB, Stern K, Brakenridge SC, Robinson BR, Wade CE, et al. PREHOSPITAL CRYSTALLOID RESUSCITATION: PRACTICE VARIATION AND ASSOCIATIONS WITH CLINICAL OUTCOMES. Shock 2023; 59(1):28-33. Medline
|
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Sanson G., Di Bartolomeo S., Nardi G., et al. Road traffic accident with vehicular entrapment: incidence of major injuries and need for advanced life support. Eur J Emerg Med 1999; 6(4):285-91. Medline
|
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Velanovich V. Crystalloid versus colloid fluid resuscitation: A meta-analysis of mortality. Surgery 1989; 105:65-71. Medline
|
|
III
|
Neutral (Yellow)
|
Volume infused
|
Process
|
PH-Paramedic
|
Dalton MA. Prehospital intravenous fluid replacement in trauma: An outmoded concept. J R Soc Med 1995; 88:213-6. Medline
|
|
III
|
Neutral (Yellow)
|
correct performance of intervention
|
Patient
|
PH-Paramedic
|
Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
|
|
III
|
Neutral (Yellow)
|
correct performance of intervention
|
Patient
|
PH-Paramedic
|
Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
|
|
III
|
Neutral (Yellow)
|
Predicted survival
|
Patient
|
SIM
|
Wears RL., Winton CN. Load and go versus stay and play: analysis of prehospital i.v. fluid therapy by computer simulation. Ann Emerg Med 1990; 19(2):163-168. Medline
|
|
III
|
Opposes (Red)
|
One hour survival
|
Patient
|
|
Kowalenko T., Stern S., Dronen S., et al. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. Jtrauma 1992; 33:349353. Medline
|
|
III
|
Opposes (Red)
|
Mean arterial pressure
|
Patient
|
|
Krausz MM., Bar-Ziv M., Rabinovici R., et al. Scoop and run or stabilize hemorragic shock with normal saline or small-volume hypertonic saline. J of Trauma 1992; 33:6-10. Medline
|
Blood transfusion
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Schoenfeld DW, Rosen CL, Harris T, Thomas SH. Assessing the one-month mortality impact of civilian-setting prehospital transfusion: A systematic review and meta-analysis. Acad Emerg Med. March 2024. Medline
|
|
II
|
Supportive (Green)
|
24 hr. survival from severe trauma
|
Patient
|
PH-Paramedic & CCT
|
Brown JBB, Sperry JL, Fombona A, Billiar TR, Peitzman AB, Guyette FX. Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air
Medical Trauma Patients. Journal of the American College of Surgeons 2015; 220(5):797-808. Medline
|
|
II
|
Supportive (Green)
|
Coagulation
|
Process
|
ED-Paramedic & MD
|
Clements T, McCoy C, Assen S, Cardenas J, Wade C, Meyer D, et al. The prehospital use of younger age whole blood is associated with an improved arrival coagulation profile. J Trauma Acute Care Surg 2021; 90(4):607-14. Medline
|
|
II
|
Supportive (Green)
|
Composite of mortality and/or a failure to reach lactate clearance
|
Patient
|
Other
|
Crombie N, Doughty HA, Bishop JRB, Desai A, Dixon EF, et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Haematol 2022; 9(4):e250–61. Medline
|
|
II
|
Supportive (Green)
|
Patient Hemodynamics
|
Patient
|
PH-Paramedic & CCT
|
Greene A, Vu EN, Archer T, Norman S, Trojanowski J, Shih AW. A Service Evaluation of Prehospital Blood Transfusion by Critical Care Paramedics in British Columbia, Canada. Air Med J 2021; 40(6):441–5. Medline
|
|
II
|
Supportive (Green)
|
6 hour mortality
|
Patient
|
PH-Paramedic
|
Gurney JM, Staudt AM, Del Junco DJ, Shackelford SA, Mann-Salinas EA, Cap AP, Spinella PC, Martin MJ. Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties. Surgery 2022; 171(2):518–25. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic & CCT
|
Guyette FX, Sperry JL, Peitzman AB, Billiar TR, Daley BJ, Miller RS, et al. Prehospital Blood Product and Crystalloid Resuscitation in the Severely Injured Patient: A Secondary Analysis of the Prehospital Air Medical Plasma Trial. Ann Surg 2021; 273(2):358-64. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic & CCT
|
Guyette FX, Zenati M, Triulzi DJ, Yazer MH, Skroczky H, Early BJ, et al. Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial. J Trauma Acute Care Surg 2022; 92(5):839–47. Medline
|
|
II
|
Supportive (Green)
|
6 and 24 hr mortality measures from trauma relative to time of platelet infusion.
|
Process
|
ED-MD
|
Hamada SR, Garrigue D, Nougue H, Meyer A, Boutonnet M, et al. Impact of platelet transfusion on outcomes in trauma patients. Crit Care 2022; 26(1):49. Medline
|
|
II
|
Supportive (Green)
|
mortality/survival
|
Patient
|
Other
|
JM G, AM S, DJ DJ, SA S, EA M-S, AP C, et al. Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties. Surgery 2021. Medline
|
|
II
|
Supportive (Green)
|
Characteristics of patient's receiving prehospital PRBC
|
Patient
|
|
Lyon RM., de Sausmarez E., McWhirter E., et al. Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017; 25(1):12. Medline
|
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
MA B, Smith A, Pokorny D, Axtman B, CP S, Barry L, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion 2021; 61(Suppl 1):S15–21. Medline
|
|
II
|
Supportive (Green)
|
Transport Times
|
Process
|
PH-Paramedic & CCT
|
Mikati N, Phillips AR, Corbelli N, Guyette FX, Liang NL. The Effect of Blood Transfusion during Air Medical Transport on Transport Times in Patients with Ruptured Abdominal Aortic Aneurysm. Prehosp Emerg Care 2021:1-8. Medline
|
|
II
|
Supportive (Green)
|
Hemodynamic stability
|
Patient
|
PH-Paramedic & CCT
|
Parker ME., Khasawneh MA., Thiels CA., Berns KS., Stubbs JR., Jenkins DH., et al. Prehospital Transfusion for Gastrointestinal Bleeding. Air Med J; 36(6) 315-9. Medline
|
|
II
|
Supportive (Green)
|
24 hour and 30 day survival
|
Patient
|
PH-Paramedic & MD
|
Shackelford SA., Del JD, Powell-Dunford N., Mazuchowski EL., Howard JT., Kotwal RS., et al. Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival. JAMA 2017; 318(16) 1581-91. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Sunde GA, Bjerkvig C, Bekkevold M, Kristoffersen EK, Strandenes G, et al. Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service. Scand J Trauma Resusc Emerg Med Dec 2022 ;30(1):65. Medline
|
|
II
|
Supportive (Green)
|
Survival to discharge
|
Process
|
Other
|
Talmy T, Malkin M, Esterson A, et al. Low-titer group O whole blood in military ground ambulances: Lessons from the Israel Defense Forces initial experience. Transfus Med Sept 2023. Medline
|
|
II
|
Supportive (Green)
|
Survival at 24 hours and 30 days
|
Patient
|
ED-MD
|
Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. JAMA Surg 2023; 158(5):532-40 Medline
|
|
II
|
Neutral (Yellow)
|
Prehospital mortality
|
Patient
|
PH-Paramedic
|
Ångerman S, Kirves H, Nurmi J. Characteristics of Nontrauma Patients Receiving Prehospital Blood Transfusion with the Same Triggers as Trauma Patients: A Retrospective Observational Cohort Study. Prehosp Emerg Care 2021:1-9. Medline
|
|
II
|
Neutral (Yellow)
|
Feasibility
|
Patient
|
PH-Paramedic & MD
|
Bodnar D, Rashford S, Hurn C, Quinn J, Parker L, Isoardi K, Williams S. Characteristics and outcomes of patients administered blood in the prehospital environment by a road based trauma response team. Emerg Med J 2014; 31:583–8. Medline
|
|
II
|
Neutral (Yellow)
|
Patient centered mortality
|
Process
|
ED-Paramedic & MD
|
Brinck T., Handolin L., Lefering R. The effect of evolving fluid resuscitation on the outcome of severely injured patients: An 8-year experience at a tertiary trauma center. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2016;105(2):109-16. Medline
|
|
II
|
Neutral (Yellow)
|
All cause mortality at 6 h
|
Patient
|
PH-Paramedic & MD
|
Griggs JE., Jeyanathan J., Joy M., Russell MQ., Durge N., Bootland D., et al. Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid. Scandinavian journal of trauma, resuscitation and emergency medicine 2018; 26(1) 100. Medline
|
|
II
|
Neutral (Yellow)
|
In-hospital mortality
|
Patient
|
In-Patient
|
Haltmeier T, Benjamin E, Gruen JP, Shulman IA, Lam L, Inaba K, et al. Decreased mortality in patients with isolated severe blunt traumatic brain injury receiving higher plasma to packed red blood cells transfusion ratios. Injury 2018; 49(1):62-6. Medline
|
|
II
|
Neutral (Yellow)
|
Incidence
|
Patient
|
PH-Paramedic & MD
|
Harris D, Martin D, Bednarz J, Ellis DY. Acute traumatic coagulopathy and the relationship to prehospital care and on-scene red blood cell transfusion. Emerg Med Australas 2021; 33(5):834–40. Medline
|
|
II
|
Neutral (Yellow)
|
Rapid thromboelastographic (Rteg)
|
Patient
|
PH-Paramedic
|
Henriksen HH., Rahbar E., Baer LA., Holcomb JB., Cotton BA., Steinmetz J., et al. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis. Scand J Trauma Resusc Emerg Med 2016; 24(1):145. Medline
|
|
II
|
Neutral (Yellow)
|
TBD
|
Process
|
PH-MD & CCT
|
Heschl S, Andrew E, de WA, Bernard S, Kennedy M, Smith K, et al. Prehospital transfusion of red cell concentrates in a paramedic-staffed helicopter emergency medical service. Emergency medicine Australasia: EMA 2018; 30(2):236-41. Medline
|
|
II
|
Neutral (Yellow)
|
3-hour, 24-hour and 30-day mortality
|
Patient
|
|
Holcomb JB, Swartz MD, DeSantis SM, Greene TJ, Fox EE, Stein DM, Bulger EM, Kerby JD, Goodman M, Schreiber MA, Zielinski MD, O’Keeffe T, Kenji Inaba K, Tomasek JS, Podbielski JM, Appana SN, Misung Yi M, Wade CE. Multicenter observational prehospital resuscitation on helicopter study. J Trauma Acute Care Surg 2017; 83(1 S1):S83-91. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
Other
|
Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. International journal of burns and trauma 2017; 7(2):17-26. Medline
|
|
II
|
Neutral (Yellow)
|
Prehospital transport times
|
Process
|
PH-Paramedic & CCT
|
Mikati N, Phillips AR, Corbelli N, Guyette FX, Liang NL. The Effect of Blood Transfusion during Air Medical Transport on Transport Times in Patients with Ruptured Abdominal Aortic Aneurysm. Prehosp Emerg Care 2021:1-8. Medline
|
|
II
|
Neutral (Yellow)
|
mortality
|
Process
|
ED-Paramedic & MD
|
O’Reilly DJ, Morrison JJ, Jansen JO, Apodaca AN, Rasmussen TE, Midwinter MJ. Prehospital blood transfusion in the en route management of severe combat trauma: A matched cohort study. J Trauma Acute Care Surg 2014; 77(3S2):S114-20. Medline
|
|
II
|
Neutral (Yellow)
|
24 hour survival
|
Patient
|
PH-Paramedic & CCT
|
Peters JH, Smulders PSH, Moors XRJ, Bouman SJM, Meijs CMEM, Hoogerwerf N, et al. Are on-scene blood transfusions by a helicopter emergency medical service useful and safe? A multicentre case-control study. European journal of emergency medicine: official journal of the European Society for Emergency Medicine 2017. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
|
Rehn M, Weaver A, Brohi K, Eshelby S, Green L, Røislien J, et al. Effect of Pre-Hospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients. Shock (Augusta, Ga) 2018. Medline
|
|
II
|
Neutral (Yellow)
|
Ionized calcium level
|
Process
|
ED-MD
|
Rushton TJ, Tian DH, Baron A, Hess JR, Burns B. Hypocalcaemia upon arrival (HUA) in trauma patients who did and did not receive prehospital blood products: a systematic review and meta-analysis. Eur J Trauma Emerg Surg February 2024. Medline
|
|
II
|
Neutral (Yellow)
|
Appropriate use
|
Process
|
PH-Paramedic & CCT
|
Thiels CA, Aho JM, Fahy AS, Parker ME, Glasgow AE, Berns KS, Habermann EB, Zietlow SP, Zielinski MD. Prehospital Blood Transfusions in Non-Trauma Patients. World J Surg 2016; 40:2297–304. Medline
|
|
II
|
Neutral (Yellow)
|
24-h mortality and 30-day mortality
|
Process
|
PH-MD & CCT
|
Tucker H, Brohi K, Tan J, et al. Association of red blood cells and plasma transfusion versus red blood cell transfusion only with survival for treatment of major traumatic hemorrhage in prehospital setting in England: a multicenter study. Crit Care 2023; 27(1):25. Medline
|
|
II
|
Neutral (Yellow)
|
Patient hypothermia
|
Patient
|
PH-Paramedic & CCT
|
Wheeler R, von Recklinghausen FM, Brozen R. Blood Administration in Helicopter Emergency Medical Services Patients Associated With Hypothermia. Air Medical Journal 2013; 32(1): 47-51. Medline
|
|
II
|
Opposes (Red)
|
Length of stay
|
Patient
|
Other
|
Hough R, Cox SC, Chimelski E, Mihm FG, Tobin JM. Prehospital Critical Care Blood Product Administration: Quantifying Clinical Benefit. Dimens Crit Care Nurs Nov 2023; 42(6):333-8. Medline
|
|
III
|
Supportive (Green)
|
Additional transfusion of blood at hospital
|
Patient
|
PH-Paramedic & MD
|
Barkana, Y, Stein M, Maor R, Lynn M, Eldad A. Prehospital Blood Transfusion in Prolonged Evacuation. The Journal of Trauma: Injury, Infection, and Critical Care 1999; 46(1):176-80. Medline
|
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Broome JM, Nordham KD, Piehl M, et al. Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle. J Trauma Acute Care Surg May 2024; 96(5):702-7. Medline
|
|
III
|
Supportive (Green)
|
Patient hemodynamics
|
Process
|
PH-Paramedic
|
Certain L, Rostirola JVC, Pereira JS, Rostirola GC, Estevam BC, Vieira CCA, et al. First immediate transfusion at a prehospital environment in Latin America: A case report. Hematol Transfus Cell Ther 2021. Medline
|
|
III
|
Supportive (Green)
|
Improvement in vital signs
|
Patient
|
PH-MD & CCT
|
Certain L, Rostirola JVC, Pereira JS, Rostirola GC, Estevam BC, Vieira CCA, et al. First immediate transfusion at a prehospital environment in Latin America: A case report. Hematol Transfus Cell Ther 2021. Medline
|
|
III
|
Supportive (Green)
|
Safe administration
|
Process
|
PH-Paramedic & CCT
|
LTC Robert F. Malsby III, MAJ Jose Quesada, MAJ Nicole Powell-Dunford, CPT Ren Kinoshita, CPT John Kurtz, CPT William Gehlen, CPT Colleen Adams, MAJ Dustin Martin, Col Stacy Shackelford. Prehospital Blood Product Transfusion by U.S. Army MEDEVAC During Combat Operations in Afghanistan: A Process Improvement Initiative. MILITARY MEDICINE 2013; 178(7):785-91. Medline
|
|
III
|
Supportive (Green)
|
Survival
|
Process
|
PH-MD & CCT
|
Puzio TJ, Meyer DE, Heft N, Nealy W, Osborn L. Continuum of Care: A Multiagency Approach to Seamless Warmed Prehospital Whole Blood Resuscitation of a Patient with Noncompressible Truncal Hemorrhage. Prehosp Emerg Care 2022; 1–4. Medline
|
|
III
|
Supportive (Green)
|
Appropriate use of blood product
|
Process
|
PH-MD & CCT
|
Raitt JE, Norris-Cervetto E, Hawksley O. A report of two years of pre-hospital blood transfusions by Thames Valley Air Ambulance. Trauma 2018; 20(3):221–4. Medline
|
|
III
|
Supportive (Green)
|
In-hospital use of platelets and FFP in the first 24h and total
|
Process
|
PH-MD & CCT
|
Rehn M., Weaver AE., Eshelby S., Rislien J., Lockey DJ. Pre-hospital transfusion of red blood cells in civilian trauma patients. Transfus Med 2017. Medline
|
|
III
|
Supportive (Green)
|
Improved hemodynamics
|
Process
|
ED-MD
|
Shand S, Curtis K, Dinh M, Burns B. Prehospital Blood Transfusion in New South Wales, Australia: A Retrospective Cohort Study. Prehosp Emerg Care 2021; 25(3):404–11. Medline
|
|
III
|
Neutral (Yellow)
|
Feasibility
|
Process
|
PH-Paramedic
|
Coyle C, Zitek T, Pepe PE, et al. The Implementation of a Prehospital Whole Blood Transfusion Program and Early Results. Prehosp Disaster Med 2023; 1-5. Medline
|
|
III
|
Neutral (Yellow)
|
Feasibility
|
Patient
|
PH-Paramedic & CCT
|
Mix F, Zielinski M, Myers L, Berns K, Luke A, Stubbs J, Sztajnkrycer M. Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study. Prehospital and Disaster Medicine 2018, 33(3):230-6. Medline
|
|
III
|
Neutral (Yellow)
|
24 hour mortality
|
Patient
|
PH-Paramedic & CCT
|
Nawrocki PS, Mulcahy B, Shukis M, Poremba M. Prehospital Use of Whole Blood for Ill and Injured Patients During Critical Care Transport. Air Med J 2022; 41(5):451–7. Medline
|
|
III
|
Neutral (Yellow)
|
Feasibility
|
Patient
|
|
Sunde GA., Vikenes B., Strandenes G., et al. Freeze dried plasma and fresh red blood cells for civilian prehospital hemorrhagic shock resuscitation. J Trauma Acute Care Surg 2015; 78(6 Suppl 1):S26-30. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Berry CL, Golden D, Tubby B, Berry S, Hall D, Christiansen G. Prehospital Massive Transfusion for Resuscitation of an Entrapped Patient in a Rural Setting: A Case Report. Prehosp Emerg Care June 2024; 1-5. Medline
|
Hypertonic Saline
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Improvement in hemodynamics
|
Patient
|
|
Ghafari MH., Moosavizadeh SA., Moharari RS., Khashayar P. Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock. Middle East J Anesthesiol 2008; 19(6):1337-47. Medline
|
|
I
|
Neutral (Yellow)
|
Survival to hospital discharge
|
Patient
|
PH-Paramedic
|
Blanchard IE, Ahmad A, Tang KL, Ronksley PE, Lorenzetti D, Lazarenko G, et al. The effectiveness of prehospital hypertonic saline for hypotensive trauma patients: a systematic review and meta-analysis. BMC emergency medicine 2017; 17(1):35. Medline
|
|
I
|
Neutral (Yellow)
|
28-day mortality
|
Patient
|
PH-Paramedic
|
Bulger EM., et al. Out-Of-Hospital Hypertonic Resuscitation After Traumatic Hypovolemic Shock. Ann Surg 2011; 253(3):431-41. Medline
|
|
I
|
Neutral (Yellow)
|
Survival
|
Patient
|
ED-MD
|
Vassar MJ., Perry CA., Holcroft JW. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. J Trauma 1993; 34(5):622-32; discussion 632-3. Medline
|
|
I
|
Neutral (Yellow)
|
Survival
|
Patient
|
ED-MD
|
Wu MC, Liao TY, Lee EM, Chen YS, Hsu WT, Lee MG, et al. Administration of Hypertonic Solutions for Hemorrhagic Shock: A Systematic Review and Meta-analysis of Clinical Trials. Anesth Analg 2017; 125(5):1549-57. Medline
|
|
II
|
Supportive (Green)
|
Hemodynamic parameters, volume expansion
|
Process
|
ED-MD
|
Younes RN., Aun F., Accioly CQ., Casale LP., Szajnbok I., Birolini D. Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992; 111(4):380-385. Medline
|
|
II
|
Neutral (Yellow)
|
Homeostatic lab values
|
Patient
|
ED-MD
|
Mauritz W., Schimetta W., Oberreither S., Polz W. Are hypertonic hyperoncotic solutions safe for prehospital small-volume resuscitation? Results of a prospective observational study. Eur J Emerg Med 2002; 9(4):315-9. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Maningas P., Mattox K., Pepe P., et al. Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. The American J Surgery 1989; 157:528-34. Medline
|
|
III
|
Supportive (Green)
|
Improved cardiac work and oxygen consumption
|
Patient
|
|
Siritongtaworn P., Moore EE., Marx JA., et al. The benefits of 7.5% NaCl/6% dextran 70 (HSD) for prehospital resuscitation of hemorrhagic shock: Improved oxygen transport. Brazilian J Med Biol Res 1989; 22:275-278. Medline
|
|
III
|
Supportive (Green)
|
Risk
|
Patient
|
ED-MD
|
Vasser MJ., Perry CA., Holcroft JW. Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Arch Surg 1990; 125:1309-1315. Medline
|
|
III
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Mattox K., Maningas P., Moore E., et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. Ann Surg 1991; 213:482-91. Medline
|
|
III
|
Neutral (Yellow)
|
Predictors of response to hypertonic saline
|
Process
|
ED-MD
|
Younes RN., Chan FA., Ching CT., et al. Prognastic factors to predict outcome following the administration of hypertonic solution in hypovolemic patients. Shock 1997; 7:79-83. Medline
|
|
III
|
Opposes (Red)
|
Mean arterial pressure
|
Patient
|
|
Krausz MM., Bar-Ziv M., Rabinovici R., et al. Scoop and run or stabilize hemorragic shock with normal saline or small-volume hypertonic saline. J of Trauma 1992; 33:6-10. Medline
|
Plasma infusion
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
30-day mortality
|
Patient
|
PH-Paramedic & CCT
|
Guyette FX, Sperry JL, Peitzman AB, Billiar TR, Daley BJ, Miller RS, et al. Prehospital Blood Product and Crystalloid Resuscitation in the Severely Injured Patient: A Secondary Analysis of the Prehospital Air Medical Plasma Trial. Ann Surg 2021; 273(2):358-64. Medline
|
|
I
|
Supportive (Green)
|
Mortality at 30 days
|
Patient
|
|
Sperry J., Guyette F., Brown J., et al. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. N Engl J Med 2018; 379(4):315-326. Medline
|
|
II
|
Supportive (Green)
|
30-day Survival
|
Patient
|
PH-Paramedic & CCT
|
Gruen DS, Guyette FX, Brown JB, Okonkwo DO, Puccio AM, Campwala IK, et al. Association of Prehospital Plasma With Survival in Patients With Traumatic Brain Injury: A Secondary Analysis of the PAMPer Cluster Randomized Clinical Trial. JAMA Network Open 2020; 3(10):e2016869. Medline
|
|
II
|
Supportive (Green)
|
Rapid thromboelastographic (Rteg)
|
Patient
|
PH-Paramedic
|
Henriksen HH., Rahbar E., Baer LA., Holcomb JB., Cotton BA., Steinmetz J., et al. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis. Scand J Trauma Resusc Emerg Med 2016; 24(1):145. Medline
|
|
II
|
Supportive (Green)
|
30 day mortality
|
Process
|
Other
|
Lewis RE, Muluk SL, Reitz KM, Guyette FX, Brown JB, Miller RS, Harbrecht BG, et al. Prehospital plasma is associated with survival principally in patients transferred from the scene of injury: A secondary analysis of the PAMPer trial. Surgery 2022. Medline
|
|
II
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic & CCT
|
Oakeshott JE., Griggs JE., Wareham GM., Lyon RM. Feasibility of prehospital freeze-dried plasma administration in a UK Helicopter Emergency Medical Service. European journal of emergency medicine 2018. Medline
|
|
II
|
Supportive (Green)
|
30 day survival
|
Patient
|
PH-Paramedic
|
Reitz KM, Gruen DS, Guyette F, Brown JB, Yazer MH, Vodovotz Y, et al. Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis. Trauma Surg Acute Care Open 2021; 6(1):e000648. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Shlaifer A, Siman-Tov M, Radomislensky I, Peleg K, Klein Y, Glassberg E, et al. The impact of prehospital administration of freeze-dried plasma on casualty outcome. The journal of trauma and acute care surgery 2019; 86(1):108-15. Medline
|
|
II
|
Supportive (Green)
|
Mortality at 30 days
|
Patient
|
PH-Paramedic & CCT
|
SP C, Lutfi W, BJ D, RS M, BG H, JA C, et al. Lactate as a mediator of prehospital plasma mortality reduction in hemorrhagic shock. J Trauma Acute Care Surg 2021; 91(1):186–91. Medline
|
|
II
|
Neutral (Yellow)
|
Pre-hospital plasma infusion impact on survival in trauma (shock) patients
|
Patient
|
PH-Paramedic & CCT
|
Abuelazm M, Rezq H, Mahmoud A, et al. The efficacy and safety of pre-hospital plasma in patients at risk for hemorrhagic shock: an updated systematic review and meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg February 2024. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality (3 hour, 24 hour, 30 day)
|
Patient
|
|
Holcomb JB, Swartz MD, DeSantis SM, Greene TJ, Fox EE, Stein DM, Bulger EM, Kerby JD, Goodman M, Schreiber MA, Zielinski MD, O’Keeffe T, Kenji Inaba K, Tomasek JS, Podbielski JM, Appana SN, Misung Yi M, Wade CE. Multicenter observational prehospital resuscitation on helicopter study. J Trauma Acute Care Surg 2017; 83(1 S1):S83-91. Medline
|
|
III
|
Neutral (Yellow)
|
28 day mortality
|
Patient
|
PH-Paramedic
|
Moore HB., Moore EE., Chapman MP., McVaney K., Bryskiewicz G., Blechar R., et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area a randomised trial. Lancet (London, England) 2018; 392(10144) 283-91. Medline
|
Restricted Crystalloids
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Survival
|
Patient
|
ED-MD
|
Bickell WH., Wall MJ., Pepe PE., et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. New Eng J Med 1994; 331(17):1105-9. Medline
|
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Schreiber MA., Meier EN., Tisherman SA., et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: Results of a prospective randomized pilot trial. J Trauma Acute Care Surg 2015; 78(4):687-95; discussion 695-7. Medline
|
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Dretzke J., Sandercock J., Bayliss S., Burls A. Clinical effectiveness and cost-effectiveness of prehospital IV fluids in trauma patients. Health Technology Assessment 2004; 8:23. Medline
|
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Hébert S, Kohtakangas E, Campbell A, Ohle R. The efficacy of prehospital IV fluid management in severely injured adult trauma patients: a systematic review and meta-analysis. CJEM 2023. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Bath MF, Schloer J, Strobel J, et al. Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries. Crit Care. March 2024; 28(1):81. Medline
|
|
II
|
Supportive (Green)
|
Prevention of status epilepticus
|
Patient
|
ED-MD
|
Brown JB., Cohen MJ., Minei JP., Maier RV., West MA., Billiar TR., et al. Goal-directed resuscitation in the prehospital setting: a propensity-adjusted analysis. J Trauma Acute Care Surg 2013; 74(5):1207-12; discussion 1212-4.
|
|
II
|
Supportive (Green)
|
Survival benefit
|
Patient
|
|
Duke MD., Guidry C., Guice J., et al. Restrictive fluid resuscitation in combination with damage control resuscitation: Time for adaptation. J Trauma Acute Care Surg 2012; 73(3):674-8. Medline
|
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Geeraedts LM Jr, Pothof LA, Caldwell E, de Lange-de Klerk ES, D'Amours SK. Prehospital fluid resuscitation in hypotensive trauma patients: do we need a tailored approach? Injury. 2015 Jan;46(1):4-9. doi: 10.1016/j.injury.2014.08.001. Epub 2014 Aug 11. PMID: 25173671. Medline
|
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Hampton DA., Fabricant LJ., Differding J., Diggs B., Underwood S., De La Cruz D., et al. Prehospital intravenous fluid is associated with increased survival in trauma patients. J Trauma Acute Care Surg 2013; 75(1S1):S9-15. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
|
Harada MY., Ko A., Barmparas G., et al. 10-year trend in crystalloid resuscitation: Reduced volume and lower mortality. International journal of surgery (London, England). 2017;38:78-82. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Hussmann B., Heuer M., Lefering R., et al. Prehospital volume therapy as an independent risk factor after trauma. Biomed Res Int 2015; 354367. Medline
|
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Patient
|
ED-MD
|
Jones DG, Nantais J, Rezende-Neto JB, Yazdani S, Vegas P, Rizoli S. Crystalloid resuscitation in trauma patients: deleterious effect of 5L or more in the first 24h. BMC surgery 2018; 18(1):93. Medline
|
|
II
|
Supportive (Green)
|
Multi-organ failure rate
|
Patient
|
PH-Paramedic
|
Regel G., Stalp M., Lehmann U., Seekamp A. Prehospital care, importance of early intervention on outcome. Acta Anaesthesiol Scand Suppl 1997; 110:71-6. Medline
|
|
II
|
Supportive (Green)
|
Identification of coagulopathy risk factors
|
Patient
|
|
Wafaisade A., Wutzler S., Lefering R., et al. Drivers of acute coagulopathy after severe trauma: A multivariate analysis of 1987 patients. Emerg Med J 2010; 27(12):934-939. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-Paramedic & MD
|
Zitek T, Ataya R, Farino L, Mohammed S, Miller G. Is the use of greater than 1 L of intravenous crystalloids associated with worse outcomes in trauma patients? Am J Emerg Med 2021; 40:32-6. Medline
|
|
II
|
Neutral (Yellow)
|
Hemodynamic recovery associated with restricted volume crystalloids
|
Process
|
ED-MD
|
Hall AB, Glas-Boben J, Santos JL, Wilson K, Morata L, Wall W. Impact of the utilization of 500 mL IV bags on crystalloid resuscitation volumes administered to trauma patients. Am J Emerg Med 2022; 51:214–7. Medline
|
|
II
|
Neutral (Yellow)
|
Coagulopathy
|
Patient
|
PH-Paramedic
|
Hubetamann B., Lefering R., Taeger G., Waydhas C., Ruchholtz S., Sven Lendemans and the DGU Trauma Registry. Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry. J Emerg Trauma Shock 2011; 4(4):465-71. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Hussmann B., Heuer M., Lefering R., et al. Prehospital volume therapy as an independent risk factor after trauma. Biomed Res Int 2015; 354367. Medline
|
|
II
|
Neutral (Yellow)
|
Safety
|
Patient
|
PH-Paramedic
|
Leenen M., Scholz A., Lefering R., Flohe S., TraumaRegister DGU . Limited volume resuscitation in hypotensive elderly multiple trauma is safe and prevents early clinical dilutive coagulopathy -- a matched-pair analysis from TraumaRegister DGU((R)). Injury 2014; 45 Suppl 3:S59-63. Medline
|
|
II
|
Opposes (Red)
|
Mortality and functional outcomes
|
Patient
|
PH-Paramedic
|
Sung CW, Sun JT, Huang EP, Shin SD, Song KJ, et al. Association between prehospital fluid resuscitation with crystalloids and outcome of trauma patients in Asia by a cross-national multicenter cohort study. Sci Rep 2022; 12(1):4100. Medline
|
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic & MD
|
Albreiki M, Voegeli D. Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: a systematic review. European journal of trauma and emergency surgery: official publication of the European Trauma Society 2018; 44(2):191-202. Medline
|
|
III
|
Supportive (Green)
|
Likelihood of successful defibrillation
|
Process
|
|
Krausz MM., Bar-Ziv M., Rabinovici R., et al. Scoop and run or stabilize hemorragic shock with normal saline or small-volume hypertonic saline. J of Trauma 1992; 33:6-10. Medline
|
|
III
|
Neutral (Yellow)
|
Predicted survival
|
Patient
|
SIM
|
Wears RL., Winton CN. Load and go versus stay and play: analysis of prehospital i.v. fluid therapy by computer simulation. Ann Emerg Med 1990; 19(2):163-168. Medline
|
Shock Prediction Tool
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
II
|
Supportive (Green)
|
Requirement for transfusion
|
Patient
|
ED-MD
|
Akaraborworn O, Siribumrungwong B, Sangthong B, Thongkhao K. Massive Blood Transfusion for Trauma Score to Predict Massive Blood Transfusion in Trauma. Crit Care Res Pract 2021; 2021:3165390. Medline
|
|
II
|
Supportive (Green)
|
Predictive ability of SI
|
Process
|
PH-Paramedic
|
Bardes JM, Price BS, Bailey H, Quinn A, et al. Prehospital shock index predicts outcomes after prolonged transport: A multicenter rural study. J Trauma Acute Care Surg April 2023; 94(4):525-31. Medline
|
|
II
|
Supportive (Green)
|
Accuracy
|
Process
|
PH-Paramedic
|
David JS, Voiglio EJ, Cesareo E, Vassal O, Decullier E, Gueugniaud PY, et al. Prehospital parameters can help to predict coagulopathy and massive transfusion in trauma patients. Vox Sang 2017; 112(6):557-66. Medline
|
|
II
|
Supportive (Green)
|
Prediction of transfusion
|
Process
|
ED-MD
|
Frohlich M., Driessen A., Bohmer A., et al. Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?-an analysis of the TraumaRegister DGU. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016;24(1):148. Medline
|
|
II
|
Supportive (Green)
|
Ability to predict need for transfusion
|
Process
|
|
Frohlich M., Driessen A., Bohmer A., Nienaber U., Igressa A., Probst C., et al. Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?-an analysis of the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med 2016; 24(1):148. Medline
|
|
II
|
Supportive (Green)
|
Need for trauma centre
|
Patient
|
|
Haider AA., Azim A., Rhee P., et al. Substituting systolic blood pressure with shock index in the national trauma triage protocol. The journal of trauma and acute care surgery 2016; 81(6):1136-1141. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Process
|
ED-MD
|
Hosseinpour H, Anand T, Bhogadi SK, Colosimo C, et al. Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients. J Surg Res July 2023; 291:204-12. Medline
|
|
II
|
Supportive (Green)
|
Feasibility of the phABC scale
|
Process
|
Other
|
Kalkwarf KJ, Goodman MD, Press GM, Wade CE, Cotton BA. Prehospital ABC Score Accurately Forecasts Patients Who Will Require Immediate Resource Utilization. South Med J 2021; 114(4):193-8. Medline
|
|
II
|
Supportive (Green)
|
Prediction of serious hemorrhagic injury
|
Patient
|
PH-Paramedic
|
Kheirbek T, Martin TJ, Cao J, Hall BM, Lueckel S, Adams CA. Prehospital shock index outperforms hypotension alone in predicting significant injury in trauma patients. Trauma Surg Acute Care Open 2021; 6(1):e000712. Medline
|
|
II
|
Supportive (Green)
|
Prediction of in-hospital mortality
|
Process
|
ED-MD
|
Kimura A., Tanaka N. Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients an analysis of the Japan Trauma Data Bank. Crit Care 2018; 22(1) 87. Medline
|
|
II
|
Supportive (Green)
|
predictor of injury severity
|
Patient
|
|
Lai WH., Rau CS., Hsu SY., et al. Using the reverse shock index at the injury scene and in the emergency department to identify high-risk patients: A cross-sectional retrospective study. International journal of environmental research and public health. 2016;13(4):357. Medline
|
|
II
|
Supportive (Green)
|
Massive blood transfusion
|
Process
|
ED-MD
|
Lee YT, Bae BK, Cho YM, Park SC, Jeon CH, Huh U, et al. Reverse shock index multiplied by Glasgow coma scale as a predictor of massive transfusion in trauma. Am J Emerg Med 2021; 46:404–9. Medline
|
|
II
|
Supportive (Green)
|
Prediction of need for massive transfusion
|
Patient
|
ED-MD
|
Mclennan JV., Mackway-Jones KC., Smith JE. Prediction of massive blood transfusion in battlefield trauma Development and validation of the Military Acute Severe Haemorrhage (MASH) score. Injury 2018; 49(2) 184-90. Medline
|
|
II
|
Supportive (Green)
|
Prediction of need for transfusion
|
Process
|
PH-Paramedic & MD
|
Plodr M, Berková J, Hyšpler R, Truhlář A, Páral J, Kočí J. Prediction of pre-hospital blood transfusion in trauma patients based on scoring systems. BMC Emerg Med 2023; 23(1):2. Medline
|
|
II
|
Supportive (Green)
|
Prediction of requirement for massive transfusion protocol activation.
|
Process
|
ED-MD
|
Schroll R, Swift D, Tatum D, Couch S, Heaney JB, Llado-Farrulla M, et al. Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury 2018; 49(1):15-9. Medline
|
|
II
|
Supportive (Green)
|
Prediction of need for blood products
|
Patient
|
In-Patient
|
Tonglet M., Lefering R., Minon JM., Ghuysen A., D'Orio V., Hildebrand F., et al. Prehospital identification of trauma patients requiring transfusion results of a retrospective study evaluating the use of the trauma induced coagulopathy clinical score (TICCS) in 33,385 patients from the TraumaRegister DGU®. Acta Chir Belg 2017; 117(6) 385-390. Medline
|
|
II
|
Supportive (Green)
|
Predicting need for massive transfusion
|
Process
|
PH-Paramedic
|
Wang IJ., Bae BK., Park SW., Cho YM., Lee DS., Min MK., et al. Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients. Am J Emerg Med 2019. Medline
|
|
II
|
Neutral (Yellow)
|
Association of initial shock index and mortality
|
Process
|
ED-Paramedic & MD
|
Braverman MA, Schauer S, Brigmon E, et al. The Impact of Prehospital Whole Blood on Hemorrhaging Trauma Patients: A Multi-Center Retrospective Study. J Trauma Acute Care Surg April 2023. Medline
|
|
II
|
Neutral (Yellow)
|
Efficacy
|
Patient
|
ED-MD
|
Day DL, Ng K, Huang JB, Severino R, Hayashi MS. Comparison of Shock Index With the Assessment of Blood Consumption Score for Association With Massive Transfusion During Hemorrhage Control for Trauma. J Trauma Nurs 2021; 28(6):341–9. Medline
|
|
II
|
Neutral (Yellow)
|
Prediction of requirement for massive
transfusion
|
Process
|
|
Rau CS., Wu SC., Kuo SC., Pao-Jen K., Shiun-Yuan H., Chen YC., et al. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index. Int J Environ Res Public Health 2016; 13(7):10.3390. Medline
|
|
III
|
Supportive (Green)
|
Anticipation of need for massive transfusion
|
Process
|
ED-MD
|
Day DL., Anzelon KM., Conde FA. Association of Prehospital Shock Index and Trauma Bay Uncrossmatched Red Blood Cell Transfusion With Multiple Transfusion. J Trauma Nurs 2016; 23(2):89-95. Medline
|
|
III
|
Supportive (Green)
|
predictability of severe hemorrhage
|
Patient
|
PH-Paramedic & MD
|
Hamada SR, Rosa A, Gauss T, Desclefs JP, Raux M, Harrois A, et al. Development and validation of a pre-hospital "Red Flag" alert for activation of intra-hospital haemorrhage control response in blunt trauma. Crit Care 2018; 22(1):113. Medline
|
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-Paramedic & MD
|
Heelan GA, Peltz ED, McIntyre RC, Vega S, Krell R, Velopulos C, et al. Effect of Pre-Hospital Use of the Assessment of Blood Consumption Score and Pre-Thawed Fresh Frozen Plasma on Resuscitation and Trauma Mortality. J Am Coll Surg 2018. Medline
|
|
III
|
Supportive (Green)
|
Supportive of modified shock prediction tool
|
Process
|
PH-MD & CCT
|
Iirola T, Björkman J, Laaksonen M, Nurmi J. Predictive value of shock index variants on 30-day mortality of trauma patients in helicopter emergency medical services: a nationwide observational retrospective multicenter study. Sci Rep Nov 2022; 12(1):19696. Medline
|
|
III
|
Supportive (Green)
|
In-hospital mortality
|
Process
|
Other
|
Kim DK, Jeong J, Shin SD, Song KJ, Hong KJ, Ro YS, et al. Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study. PLoS One 2021; 16(10):e0258811. Medline
|
|
III
|
Supportive (Green)
|
Validity
|
Process
|
PH-Paramedic
|
Terceros-Almanza LJ, García-Fuentes C, Bermejo-Aznárez S, Prieto Del PI, Mudarra-Reche C, Domá-nguez-Aguado H, et al. Prediction of massive bleeding in a prehospital setting: validation of six scoring systems. Medicina intensiva 2018. Medline
|
|
III
|
Neutral (Yellow)
|
The accuracy of the Shock Index (SI)and pulse pressure/Heart Rate (PP/HR) to predict massive transfusion after severe trauma.
|
Process
|
|
Pottecher J., Ageron FX., Fauche C., Chemla D., Noll E., Duranteau J., et al. Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma: Retrospective analysis of a large regional trauma database. J Trauma Acute Care Surg 2016; 81(4):713-22. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Peltan ID., Rowhani-Rahbar A., Vande Vusse LK., Caldwell E., Rea TD., Maier RV., et al. Development and validation of a prehospital prediction model for acute traumatic coagulopathy. Crit Care 2016; 20(1):371. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Powell B, Cramb S. The shock index predicts in-flight blood transfusion in aeromedical trauma patients. Emerg Med Australas. 2024 Apr 11. doi: 10.1111/1742-6723.14413. Epub ahead of print. PMID: 38602079. Medline
|
Tranexamic Acid
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Mortality (at 24h, 48h, 1 month)
|
Patient
|
ED-Paramedic & CCP
|
Biffi A, Porcu G, Castellini G, et al. Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review. Eur J Trauma Emerg Surg Dec 2022. Medline
|
|
I
|
Supportive (Green)
|
Adverse events
|
Patient
|
PH-Paramedic
|
Deeb AP, Hoteit L, Li S, Guyette FX, Eastridge BJ, Nirula R, Vercruysse GA, O'Keeffe T, Joseph B, Neal MD, Sperry JL, Brown JB. Prehospital synergy: Tranexamic acid and blood transfusion in patients at risk for hemorrhage. J Trauma Acute Care Surg 2022. Medline
|
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Ker K. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database of Systematic Reviews 2015:5. Medline
|
|
I
|
Supportive (Green)
|
Mortality/survival
|
Patient
|
PH-Paramedic
|
Li SR, Guyette F, Brown J, Zenati M, Reitz KM, Eastridge B, et al. Early Prehospital Tranexamic Acid Following Injury is Associated with a 30-day Survival Benefit: A Secondary Analysis of a Randomized Clinical Trial. Ann Surg 2021. Medline
|
|
I
|
Supportive (Green)
|
28 day survival
|
Patient
|
PH-Paramedic
|
Mazzei M, Donohue JK, Schreiber M, et al. Prehospital tranexamic acid is associated with a survival benefit without an increase in complications: results of two harmonized randomized clinical trials. J Trauma Acute Care Surg. March 2024. Medline
|
|
I
|
Supportive (Green)
|
Need for blood transfusion
|
Patient
|
OR
|
Montroy J, Hutton B, Moodley P, Fergusson NA, Cheng W, Tinmouth A, Lavallée LT, Fergusson DA, Breau RH.The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. Transfus Med Rev. 2018 [Epub ahead of print] Medline
|
|
I
|
Supportive (Green)
|
Death
|
Patient
|
ED-MD
|
Roberts I., Shakur H., Coats T., et al. The CRASH-2 trial: A randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013; 17(10):1-79. Medline
|
|
I
|
Neutral (Yellow)
|
30-day mortality from trauma
|
Patient
|
PH-Paramedic & CCT
|
Guyette FX, Brown JB, Zenati MS, Early-Young B, Adams PW, Eastridge BJ, et al. Tranexamic Acid during Prehospital Transport in Patients at Risk for Hemorrhage after Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surgery 2020. Medline
|
|
I
|
Neutral (Yellow)
|
Survival neurologically intact 6 months post injury
|
Patient
|
PH-Paramedic
|
PATCH-Trauma Investigators and the ANZICS Clinical Trials Group; Gruen RL, Mitra B, Bernard SA, McArthur CJ, et al. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med 2023. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic & CCT
|
Almuwallad A, Cole E, Ross J, Perkins Z, Davenport R. The Impact of Pre-Hospital TXA on Mortality among Bleeding Trauma Patients: A Systematic Review and Meta-Analysis. J Trauma Acute Care Surg 2021. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Cole E., Davenport R., Willett K., Brohi K. Tranexamic acid use in severely injured civilian patients and the effects on outcomes: A prospective cohort study. Ann Surg 2015; 261(2):390-4. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Eckert MJ., Wertin TM., Tyner SD., Nelson DW., Izenberg S., Martin MJ. Tranexamic acid administration to pediatric trauma patients in a combat setting: The pediatric trauma and tranexamic acid study (PED-TRAX). J Trauma Acute Care Surg 2014; 77(6):852-8, discussion 858. Medline
|
|
II
|
Supportive (Green)
|
24-hour mortality
|
Patient
|
PH-Paramedic
|
El-Menyar A., Sathian B., Asim M., Latifi R., Al-Thani H. Efficacy of prehospital administration of tranexamic acid in trauma patients A meta-analysis of the randomized controlled trials. Am J Emerg Med 2018; 36(6) 1079-87. Medline
|
|
II
|
Supportive (Green)
|
Cellular damage
|
Patient
|
ED-Paramedic & MD
|
Gruen DS, Brown JB, Guyette FX, Johansson PI, Stensballe J, et al. Prehospital tranexamic acid is associated with a dose-dependent decrease in syndecan-1 after trauma: A secondary analysis of a prospective randomized trial. J Trauma Acute Care Surg 2023. Medline
|
|
II
|
Supportive (Green)
|
In Hospital mortality at 24 and 48 hours
|
Patient
|
PH-Paramedic
|
Morrison JJ., Dubose JJ., Rasmussen TE., Midwinter MJ.. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg 2012; 147(2):113-9. Medline
|
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Patient
|
PH-Paramedic
|
Morrison JJ., Ross JD., Dubose JJ., Jansen JO., Midwinter MJ., Rasmussen TE. Association of cryoprecipitate and tranexamic acid with improved survival following wartime injury: Findings from the MATTERs II study. JAMA Surg 2013; 148(3):218-25. Medline
|
|
II
|
Supportive (Green)
|
Mortality recorded at 24 hours
|
Patient
|
PH-Paramedic
|
Neeki MM, Dong F, Toy J, Vaezazizi R, Powell J, Wong D, et al. Tranexamic Acid in Civilian Trauma Care in the California Prehospital Antifibrinolytic Therapy Study. The western journal of emergency medicine 2018; 19(6):977-86. Medline
|
|
II
|
Supportive (Green)
|
Blunting of measures of coagulopathy
|
Patient
|
PH-Paramedic & CCT
|
Stein P., Studt JD., Albrecht R., Maller S., von Ow D, Fischer S., et al. The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients. Anesth Analg 2018; 126(2) 522-9. Medline
|
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Wafaisade A., Lefering R., Bouillon B., Bohmer AB., Gassler M., Ruppert M., et al. Prehospital administration of tranexamic acid in trauma patients. Crit Care 2016; 20(1):143-016-1322-5. Medline
|
|
II
|
Neutral (Yellow)
|
30 day mortality
|
Patient
|
PH-MD & CCT
|
Bossers SM, Loer SA, Bloemers FW, Den Hartog D, Van Lieshout EMM, Hoogerwerf N, et al. Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury. JAMA Neurol 2021; 78(3):338-45. Medline
|
|
II
|
Neutral (Yellow)
|
In hospital mortality
|
Patient
|
ED-Paramedic & MD
|
Boutonnet M., Abback P., Le Sachac F., Harrois A., Follin A., Imbert N., et al. Tranexamic acid in severe trauma patients managed in a mature trauma care system. The journal of trauma and acute care surgery 2018; 84(6) S54-62. Medline
|
|
II
|
Neutral (Yellow)
|
Hospital length of stay
|
Patient
|
Other
|
Cornelius BG., McCarty K., Hylan K., Cornelius A., Carter K., Smith KWG., et al. Tranexamic Acid Promise or Panacea The Impact of Air Medical Administration of Tranexamic Acid on Morbidity, Mortality, and Length of Stay. Advanced emergency nursing journal; 40(1) 27-35. Medline
|
|
II
|
Neutral (Yellow)
|
Appropriate use
|
Process
|
PH-Paramedic
|
Kheirbek T, Jikaria N, Murray B, Martin TJ, Lueckel SN, Stephen AH, et al. Unjustified Administration in Liberal Use of Tranexamic Acid in Trauma Resuscitation. J Surg Res 2021; 258:125-31. Medline
|
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Neeki MM, Dong F, Toy J, Vaezazizi R, Powell J, Jabourian N, et al. Efficacy and Safety of Tranexamic Acid in Prehospital Traumatic Hemorrhagic Shock: Outcomes of the Cal-PAT Study. The western journal of emergency medicine 2017; 18(4):673-83. Medline
|
|
II
|
Neutral (Yellow)
|
Myocardial injury
|
Patient
|
ED-Paramedic & MD
|
Stroda A, Thelen S, M’Pembele R, et al. Possible effect of the early administration of tranexamic acid on myocardial injury in patients with severe trauma. J Thromb Thrombolysis February 2024; 57(2 PG-179-185):179-185. Medline
|
|
II
|
Neutral (Yellow)
|
Development of ARDS
|
Patient
|
In-Patient
|
Taghavi S, Chun T, Bellfi L, Malone C, Oremosu J, Ali A, et al. A Propensity-Matched Analysis of Tranexamic Acid and Acute Respiratory Distress Syndrome in Trauma Patients. J Surg Res 2022; 280:469–74. Medline
|
|
II
|
Neutral (Yellow)
|
In-hospital mortality
|
Patient
|
PH-Paramedic
|
Van Wessem KJP, Jochems D, Leenen LPH. The effect of prehospital tranexamic acid on outcome in polytrauma patients with associated severe brain injury. Eur J Trauma Emerg Surg 2021; 1–11. Medline
|
|
II
|
Neutral (Yellow)
|
Neutral on TXA Administration
|
Patient
|
Other
|
Van Wessem KJP, Leenan LPH. Does Liberal Prehospital and In-Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study. World J Surg 2021; 45(8):2398–407. Medline
|
|
II
|
Neutral (Yellow)
|
Adverse outcomes
|
Patient
|
PH-Paramedic
|
van Wessem KJP, Leenen LPH. Does Liberal Prehospital and In-Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study. World J Surg 2021; 45(8):2398-407. Medline
|
|
II
|
Opposes (Red)
|
Reliability
|
Process
|
PH-Paramedic
|
Valle EJ., Allen CJ., Van Haren RM., et al. Do all trauma patients benefit from tranexamic acid? J Trauma Acute Care Surg 2014; 76(6):1373-1378. Medline
|
|
III
|
Supportive (Green)
|
In hospital 24 hr mortality from penetrating trauma.
|
Patient
|
PH-Paramedic
|
Broome JM, Nordham KD, Piehl M, et al. Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle. J Trauma Acute Care Surg May 2024; 96(5):702-7. Medline
|
|
III
|
Supportive (Green)
|
Management of hemorrhagic shick
|
Patient
|
PH-Paramedic
|
Cathers AD, Forsythe J, Sippel N, Williamson C, Kohler JE, Brazelton TB, et al. Tranexamic Acid Use in Pediatric Hemorrhagic Shock From Farm-Related Trauma: A Case Report. Air Med J 2020; 39(5):414-6. Medline
|
|
III
|
Supportive (Green)
|
Managing hemorrhagic shock
|
Patient
|
PH-MD & CCT
|
Lima LPST, Santos PRS, Martins HJ, Rodrigues DAS, Silva LM, Libardi MBO, et al. Use of Tranexamic Acid in Traumatic Resuscitation in a Prehospital Setting: A Case Report. Air Med J 2021; 40(5):359–62. Medline
|
|
III
|
Supportive (Green)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Vu EN, Wan WCY, Yeung TC, Callaway DW. Intramuscular Tranexamic Acid in Tactical and Combat Settings. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals; 18(1):62-8. Medline
|
|
III
|
Neutral (Yellow)
|
Hyperfibrinolysis (ROTEM)
|
Patient
|
|
Kunze-Szikszay N., Krack LA., Wildenauer P., et al. The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: A prospective observational study in pre-hospital emergency medicine. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016; 24(1):122. Medline
|
|
III
|
Opposes (Red)
|
Adverse event
|
Patient
|
ED-MD
|
Carroll ND., Restrepo CS., Eastridge BJ., Stasik CN. Left atrial thrombi following tranexamic acid in a bleeding trauma patient-A word of caution. J Card Surg 2018; 33(2) 83-5. Medline
|