Iyer D1, Lanesman L1
1Careflight
Biography:
Dr Dushyant Iyer is an anaesthetist at Royal North Shore Hospital and a Retrieval Specialist with CareFlight in New South Wales, Australia. He is involved in the prehospital and interfacility management of critically ill and injured patients, with a particular interest in trauma resuscitation, haemorrhage control, and transfusion strategies. His clinical work spans operating theatre and aeromedical retrieval environments, supporting high-acuity care in challenging settings.
Abstract
Aims
To determine the prevalence of early fibrinogen deficiency in trauma patients receiving prehospital blood transfusion, and to identify injury patterns and physiological features associated with low fibrinogen levels.
Methods
This retrospective observational cohort study will include all adult trauma patients (≥18 years) attended by the CareFlight Rapid Response Helicopter who received prehospital blood transfusion for suspected haemorrhage between 2021 and 2026. First measured fibrinogen levels—either laboratory plasma fibrinogen concentration or viscoelastic testing (FIBTEM A5)—will be obtained from receiving hospitals. Fibrinogen deficiency will be defined as plasma fibrinogen <2.0 g/L or FIBTEM A5 <12 mm. Injury patterns, mechanism of injury, and prehospital physiological parameters will be extracted from retrieval records and analysed for association with fibrinogen levels.
Results
During the study period, 205 patients received prehospital transfusion for suspected haemorrhage. We anticipate identifying a cohort of severely injured patients, with a substantial proportion demonstrating early fibrinogen deficiency. We hypothesise that specific injury patterns—including major blunt trauma, pelvic fractures, and polytrauma—will be associated with lower fibrinogen levels. Prehospital physiological derangement (e.g. hypotension and tachycardia) is also expected to correlate with hypofibrinogenaemia.
Conclusions
Early fibrinogen deficiency is likely common among severely injured patients requiring prehospital transfusion. Identifying clinical predictors of hypofibrinogenaemia may enable more targeted and timely fibrinogen replacement in the prehospital setting. These findings may inform service-level decision-making regarding the integration of fibrinogen concentrate into prehospital transfusion protocols.