We're launching with a landmark new study which will eventually see medical teams at London's Air Abulance deliver whole blood transfusions at the roadside to critically injured patients in the capital.
The blood product to be introduced today across London’s Air Ambulance’s aircraft and rapid response cars will contain red blood cells and plasma in a single unit. A team of senior doctors from Barts Health NHS Trust and Queen Mary University of London identified the need for this feasibility study. This innovation improves upon current treatment by adding plasma to the transfusion bag. This will reduce the time for patients to receive effective therapy and may improve survival figures. “Red cells & plasma” is the next step in a clinical journey to eventually add platelets and deliver whole blood transfusion.
Approximately 100 people each year in London suffer traumatic injuries that result in such serious bleeding that they may die before reaching hospital. The new blood product contains essential clotting ingredients to help form stronger blood clots and replace lost blood volume. “Red cells & plasma” will specifically help this group of 100 patients, improving their chance of survival to hospital.
Leading the study is Dr Anne Weaver, Consultant in Pre-Hospital Care at London’s Air Ambulance and Clinical Director of Trauma at The Royal London Hospital, Barts Health NHS Trust, and Dr Laura Green consultant Haematologist at NHSBT and Barts Health NHS Trust. Speaking ahead of the start of the study launch Dr Weaver said:
“As the first UK air ambulance to deliver pre-hospital blood transfusion this project builds on previous work to place us at the forefront of prehospital transfusion research. At London’s Air Ambulance we always want to give the gold standard of care to patients and the introduction of the new blood product will significantly improve the chances of survival for critically injured patients with severe blood loss, allowing them the chance to arrive at hospital.
The whole team behind the project would like to thanks Barts Charity, Saracens, and The Henry Surtees Foundation for their generous support. Thanks to them, we have the potential to save more lives in London.”
Dr Green, who has an active research portfolio in acquired bleeding disorders and joint appointments at NHSBT, Barts Health NHS Trust and QMUL, identified an opportunity for all the organisations to collaborate on this project.
Dr Green said:
“The strength of this study is the highly expert and multi-disciplinary collaboration between funding charities (London’s Air Ambulance and Barts Charity), NHSBT, QMUL and Barts Health Trust. The output of this study will be instrumental in informing the design of the future trial, which will determine the most appropriate transfusion strategy for patients who are bleeding in the pre-hospital setting. This in turn will lead to improvements in patient’s outcomes.”
The product will be delivered clinically by London’s Air Ambulance, the charity that delivers an advanced trauma team to critically injured patients in the capital. The charity treats serious traumatic injuries sustained for example as a result of road traffic collisions or penetrating trauma. The service delivers a senior doctor and paramedic team to the patient carrying out procedures on the roadside that would usually only be found in a hospital Emergency Department. The service’s unique exposure to severely injured trauma patients provides an opportunity to assess the clinical benefits of the new blood product.
London’s Air Ambulance currently use a pre-hospital “blood” transfusion of red blood cells only, which provides volume replacement and oxygen delivery to tissues. Since the product was introduced in 2012 as a world first, there has been a reduction in prehospital mortality from 34% to 19%.
The new study will assess patient outcome by comparing the current blood product against the new blood product, and will also compare transfusion data from Kent Surrey & Sussex Air Ambulance, Thames Valley Air Ambulance and the Great North Air Ambulance Service.
Study investigator Dr Ross Davenport, Senior Lecturer in Trauma Sciences at Queen Mary University of London and consultant trauma and vascular surgeon at Barts Health NHS Trust said:
“Experience from various military conflicts in the mid-20th century found whole blood to be a life-saving treatment for major bleeding but in order to meet the needs of non-bleeding patients in civilian practice, blood was separated into its various components for individualized transfusion.
“We now know patients who bleed from trauma require all components of blood and this product may offer a more effective way to stop bleeding. Further work is ongoing with NHS Blood & Transplant to develop a complete whole blood product that contains platelets – the small clotting particles in the blood that plug holes in damaged blood vessels and support the blood clot.”
This study is the next step in the journey towards London’s Air Ambulance delivering whole blood transfusions, containing red blood cells, plasma and platelets, at the roadside. The aim is to further reduce deaths due to catastrophic bleeding. If successful, NHSBT hope to extend availability and practice across the UK to other providers, in order to deliver a clinical advantage to critically injured patients who otherwise would not survive.
This important trial has been supported by Barts Charity, Saracens, and The Henry Surtees Foundation. Barts Charity has provided £100k of funding, and their Director of Grants, Francesca Gliubich said;
“Dr Weaver and her team are working relentlessly to improve pre-hospital transfusion procedures, continuously improving survival rates for victims of traumatic injuries where heavy bleeding is involved. We are proud of supporting her in this pursuit of the best care for all trauma sufferers.”
Saracens Chief Community Officer Gordon Banks said:
“As Saracens official charity partner for 2018-19 we are extremely proud to be working with London’s Air Ambulance and its partners to deliver this vital piece of research. Saracens and Saracens Sport Foundation share a passion for high performance and pushing boundaries with London’s Air Ambulance and this whole blood research is a great example of the charity’s drive to help save the lives of even more Londoners.”
Trustee of The Henry Surtees Foundation, Leonora Martell-Surtees said;
“With a background in motorsport, my father John Surtees spent his life largely chasing time round the race tracks of the world. He knew that every second counts and none more so than for Air Ambulance services when accidents or illnesses occur. With swift medical intervention provided by Air Ambulance crews, it gives a patient a far greater chance of survival and subsequent quality of life. The blood on board initiative is one that he whole heartedly supported”.