A/Prof. Ben Meadley
1Ambulance Victoria and Monash University, ,
Abstract:
Aims: The appropriate use of blood components is essential for ethical use of a precious, donated product. The aim of this study was to report in- hospital red blood cell (RBC) transfusion after pre-hospital transfusion by helicopter emergency medical service paramedics. A secondary aim was to assess the potential for venous blood lactate to predict ongoing transfusion.
Methods: All patients who received RBC in air ambulance were transported to a single adult major trauma centre, had venous blood lactate measured on arrival and did not die before ability to transfuse RBC were included. The association of venous blood lactate with ongoing RBC transfusion was assessed using multi- variable logistic regression analysis and reported using adjusted odds ratios (aOR). The discriminative ability of venous blood lactate was assessed using area under receiver operating characteristics curve (AUROC).
Results: From 1 January 2016 to 15 May 2019, there were 165 eligible patients, and 128 patients were included. In-hospital transfusion occurred in 97 (75.8%) of patients. Blood lactate was associated with ongoing RBC transfusion (aOR: 2.00; 95% confidence interval [CI]: 1.36–2.94). Blood lactate provided acceptable discriminative ability for ongoing transfusion (AUROC: 0.78; 95% CI: 0.70–0.86).
Conclusions: After excluding patients with early deaths, a quarter of those who had prehospital RBC transfusion had no further transfusion in hospital. Venous blood lactate appears to provide value in identifying such patients. Lactate levels after pre- hospital transfusion could be used as a biomarker for transfusion requirement after trauma.
Biographies:
Ben Meadley is a registered paramedic who commenced his career with Ambulance Victoria in 1998, followed by a period with New South Wales Ambulance from 1999-2003. Returning to Ambulance Victoria, Ben trained as an intensive care (MICA) paramedic in 2004, and an intensive care (MICA) flight paramedic in 2009. Ben completed his PhD at Monash University, investigating the physiological and cardiometabolic health of paramedics. Ben has developed expertise in prehospital critical care, paramedic education, and human performance in specialist teams. His research interests include respiratory and cardiovascular physiology, point of care ultrasound, blood component use in critical care, human performance optimisation, and helicopter search and rescue operations. Ben currently divides his time between clinical, systems improvement and research roles. He is a Fellow of the Australasian College of Paramedicine and was awarded the Ambulance Service Medal in 2023.