A pilot study of stored low titer group O whole blood + component therapy versus component therapy only for civilian trauma patients

Abstract

BACKGROUND:This pilot assessed transfusion requirements during resuscitation with whole blood followed by standard component therapy (CT) versus CT alone, during a change in practice at a large urban Level I trauma center. METHODS:This was a single-center prospective cohort pilot study. Male trauma patients received up to 4 units of cold-stored low anti-A, anti-B group O whole blood (LTOWB) as initial resuscitation followed by CT as needed (LTOWB + CT). A control group consisting of women and men who presented when LTOWB was unavailable, received CT only (CT group). Exclusion criteria included antiplatelet or anticoagulant medication and death within 24 hours. The primary outcome was total transfusion volume at 24 hours. Secondary outcomes were mortality, morbidity, and intensive care unit-and hospital-free days. RESULTS:Thirty-eight patients received LTOWB, with a median of 2.0 (interquartile range [IQR] 1.0-3.0) units of LTOWB transfused. Thirty-two patients received CT only. At 24 hours after presentation, the LTOWB +CT group had received a median of 2,138 mL (IQR, 1,275-3,325 mL) of all blood products. The median for the CT group was 4,225 mL (IQR, 1,900-5,425 mL; p = 0.06) in unadjusted analysis. When adjusted for Injury Severity Score, sex, and positive Focused Assessment with Sonography for Trauma, LTOWB +CT group patients received 3307 mL of blood products, and CT group patients received 3,260 mL in the first 24 hours (p = 0.95). The adjusted median ratio of plasma to red cells transfused was higher in the LTOWB + CT group (0.85 vs. 0.63 at 24 hours after admission; p = 0.043. Adjusted mortality was 4.4% in the LTOWB + CT group, and 11.7% in the CT group (p = 0.19), with similar complications, intensive care unit-, and hospital-free days in both groups. CONCLUSION:Beginning resuscitation with LTOWB results in equivalent outcomes compared with resuscitation with CT only.

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

“…In subanalysis of civilian studies, early and 24-hour mortality was lower for patients transfused with WB ± BCT as compared with BCT. These findings are in contrast to other published reviews (summarized in Supplementary Digital Content 14, http://links.lww.com/TA/D6), which can be explained by the fact that this study includes more patients in the meta-analysis 21–27 …”

“…Comparative studies were conducted in both military (n = 7) setting [40][41][42][43][44][45][46] and civilian (n = 20) setting. 11,13,19,[21][22][23][24][25][26][27][47][48][49][50][51][52][53][54][55][56] Baseline characteristics and outcomes of patients included in the studies are summarized in Supplementary Digital Content 6, http://links.lww.com/TA/D6. In-and exclusion criteria, statistics and conclusions are summarized in Supplementary Digital Content 7, http://links.lww.com/TA/D6 and transfusion data including used amounts of WB and BCT, as well as product/RBC ratios are summarized in Supplementary Digital Content 8, http://links.…”

Sangre total leucorreducida y filtro ahorrador de plaquetas preserva su función hemostática por 21 días: ¿La resucitación hemostática podría ser una realidad en Colombia?

“…El uso de sangre total ya ha comenzado a ser evaluado en el manejo del trauma civil. Siletz y colaboradores 23 presentaron los resultados de un estudio piloto donde compararon pacientes tratados con sangre total y terapia de hemocomponetes versus pacientes tratados únicamente con hemocomponentes, encontrando una relación de transfusión de glóbulos rojos: plasma superior en el grupo de sangre total. La mortalidad asociada en este grupo de sangre total y terapia de hemocomponetes fue del 4,4 % en comparación con el grupo de la terapia convencional, donde fue del 11,7 %, pero la diferencia no fue estadísticamente significativa.…”

Transfusion management in the trauma patient

“…Similarly, a prospective evaluation of pediatric patients receiving massive transfusion showed LTOWB administration during the early resuscitation was associated with decreased mortality at 72 h and 28 days [56 ▪▪ ]. Conversely, a recent prospective analysis failed to show better outcomes when resuscitation was started with 2 units of LTOWB before switching to component therapy [57 ▪ ].…”