357 © Springer Nature Switzerland AG 2021 C. S. Scher et al. (eds.), Essentials of Blood Product Management in Anesthesia Practice, https://doi.org/10.1007/978-3-030-59295-0_36 Prehospital Transfusions by First Providers Marie-Christine Wright, Chikezie N. Okeagu, Alaina L. Broussard, Keith P. Delaune, Shukan Patel, Elyse M. Cornett, and Alan David Kaye Introduction In 1628, English physician William Harvey published his landmark work, Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (commonly De motu cordis), in which he described the circulation of blood in the body by the heart. Although it was widely accepted that blood played an essential role in the sustenance of life, little was known about how it was delivered to the tissues to serve this vital function. In fact, the prevailing belief theorized by Galen ~1500 years earlier stated that blood was continuously pro- duced and distributed by the liver and completely absorbed by the tissues [1]. His discovery led to intense investigation into blood circulation, resulting in successful transfusion experiments in animals within a few decades of the publica- tion of De motu cordis, and ultimately culminating in the successful transfusion of human blood by Dr. James Blunndell in 1818 [2, 3]. Today, blood transfusion is the most common procedure performed in US hospitals [4]. The indications for blood transfusion are vast and include a number of conditions that result in blood loss and anemia, including hemorrhage [5]. Hemorrhage is responsible for up to 40% of deaths in trauma [6]. Massive hemorrhage also presents a host of physiological derangements that jeopardize the survival of trauma patients. Recognized as the “triad of death,” the combination of hypothermia, metabolic acidosis, and coagulopathy, when present, portends a poor prognosis (see Fig. 36.1). Severe hemorrhage can directly lead to hypo- thermia. Failure to control hemorrhage leads to increased sympathetic tone, which diverts blood away from non-vital organs in an attempt to preserve perfusion of vital organs. This eventually leads to a mismatch between oxygen demand and oxygen delivery, forcing the body to rely on anaerobic metabolism, which results in the accumulation of acidic com- pounds such as lactic acid and ketone bodies. It also results in a drop in pH and the development of metabolic acidosis. In an attempt to control the massive blood loss, the body activates the coagulation cascade, and clotting factors are quickly depleted leading to a consumptive coagulopathy. Furthermore, these derangements each can potentiate each other leading to worsening acidosis, coagulopathy, and hypothermia [7–10]. The recognition that promptly addressing these factors gives patients the best chance at a favorable outcome has led to the development of various damage control resuscitation (DCR) strategies [11]. Transfusion of blood products is a staple of DCR protocols and one of the frst tools employed upon the arrival of the patient at a trauma center [6, 10, 11]. However, elements of the triad can present within minutes, long before patients arrive at the hospital [12, 13]. In fact, up to 56% of trauma patients die before arrival at the hospital [14]. As such, there has been much interest in resuscitation 36 M.-C. Wright University of Toledo School of Medicine, Department of Pediatrics, Toledo, LA, USA e-mail: Marie.wright@utoledo.edu C. N. Okeagu Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA e-mail: cokeag@lsuhsc.edu A. L. Broussard · K. P. Delaune Ochsner Clinic, Department of Anesthesiology, New Orleans, LA, USA e-mail: Alaina.broussard@ochsner.org; keith.delaune@ochsner.org S. Patel Department of Anesthesiology, LSU Health Sciences Center, New Orleans, LA, USA e-mail: spat23@lsuhsc.edu E. M. Cornett (*) Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA e-mail: ecorne@lsuhsc.edu A. D. Kaye Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine-Shreveport, Shreveport, LA, USA LSU Health Shreveport School of Medicine, New Orleans, LA, USA Tulane School of Medicine, New Orleans, LA, USA e-mail: akaye@lsuhsc.edu