A new program by Cleveland EMS to deliver blood transfusions to critically injured patients at risk of bleeding out is showing positive results just nine months in, leaders say.
The number of people who received blood is relatively small so far – about 60 as of late March. But the majority of residents who received blood from EMS lived to be discharged from the hospital, which is the measure of success leaders tracked. Patients who receive blood from EMS are often so injured that survivability is in doubt.
“What we found was: it’s safe, and it’s doable and it is benefiting patients,” said Dr. Jeremiah Escajeda, the medical director for Cleveland’s Department of Public Safety and an emergency medicine physician at MetroHealth.
Currently, the program only treats people with traumatic injuries, such as those who have been in car accidents or with gunshot wounds. The blood is delivered to the patient as the ambulance is moving to the hospital.
More research is needed to certify whether patients who received blood are surviving at higher rates than similar patients who historically did not receive it, but Escajeda said that anecdotally it appears that they are. He also hopes to study different outcome measures, such as whether the patient survived 30 days after they received whole blood. That data is more difficult to access.
The program, one of the first in Ohio, was complex to set up and expensive to undertake. The department is giving out whole blood – which is about two to five times pricier per unit than other types of liquid, like red blood cells or liquid plasma.
Leaders at Cleveland EMS and MetroHealth decided to pursue the program because a growing body of research shows that providing blood to injured patients quickly can increase the likelihood of survival.
After starting the program last June on Cleveland’s Southeast Side, the EMS department expanded it to cover the entire city starting last October. More expansions are on the horizon: The program hopes soon to have the ability to treat even younger children and patients bleeding due to medical reasons, said Jonathan Wearstler, Commander of Operations with Cleveland EMS, who oversees the whole blood program. Medical reasons can include excessive bleeding after giving birth or internal bleeds from ulcers.
Three EMS captains stationed throughout the city carry the blood and are dispatched to all traumatic injuries that might require blood, Wearstler said.
Suggested Reading
Who’s benefiting? Mostly men, many gun violence victims
Escajeda and Wearstler analyzed the 50 patients who received blood in the program’s first seven months in operation.
They found about two-thirds of all patients who received a blood transfusion survived to be discharged from the hospital.
That grew even higher – to 83% – when certain patients who Escajeda and Wearstler felt couldn’t be properly analyzed were excluded. That included seven patients who were experiencing what’s called traumatic arrest, which is when someone is so severely injured that they often have almost no pulse. All of these patients died despite a blood transfusion.
“If you’re at the point where your heart has already stopped or you’re in what’s called traumatic arrest, administering blood does not bring you back from death,” Escajeda said.
Among the smaller set of patients, vital signs like blood pressure and heart rate improved after they received a blood transfusion, the analysis found.
The numbers don’t prove blood transfusions saved Clevelanders’ lives or improved their vital signs, Escajeda said. To determine that, a randomized control trial is necessary.
“But it definitely signals that it’s headed in the right direction that we anticipated and expect for patient benefit,” he said.
Randomized control trials have been done in other settings: one randomized control trial from 2018 found a nearly 10-percentage point lower mortality rate in trauma patients who received plasma pre-hospital compared to standard resuscitation care. Whole blood has been found to have even better survival rates than plasma.
Patients in the smaller dataset who received blood were overwhelmingly male, and the majority were suffering a gunshot wound. On average, they were about 36 years old.
The total number of patients treated so far has been fairly limited because the program didn’t expand across the entire city until the fall, which is when traumatic injuries typically drop after spiking during the summer, Wearstler and Escajeda said. Firearm injuries in particular rise during the summer.
Wearstler added that Cleveland EMS is collecting data on “near misses” — people who likely qualified for a blood transfusion but didn’t receive one — to understand how the program can expand going forward.