Effectiveness and safety of whole blood compared to balanced blood components in resuscitation of hemorrhaging trauma patients - A systematic review

Malkin, Michael; Nevo, Andrey; Brundage, Susan I.; Schreiber, Martin A.

doi:10.1016/j.injury.2020.10.095

Cited by 42 publications

(37 citation statements)

References 34 publications

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“…The small number of cases treated by the IDF-CSAR with LTOWB makes it impossible to make a clear conclusion regarding the safety of LTOWB administration. However, our results are in accord with other articles that demonstrate the safety of LTOWB [27,28]. Based on the accumulating data from the practices in other countries and our experience, MDABS is considering instituting a more permissive antibody titer threshold of <100, which will enable the blood center to more easily meet the increasing demand for LTOWB from both the pre-and in-hospital systems.…”

Section: Discussionsupporting

confidence: 89%

Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years’ Experience

Levin

Zur

Shinar

et al. 2021

Transfus Med Hemother

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Introduction: The Israeli Defense Forces Medical Corps (IDF-MC) implemented the use of low-titer group O whole blood (LTOWB) as the first-choice resuscitation fluid in the IDF airborne Combat Search and Rescue Unit (IDF-CSAR) for aerial evacuation of both military and civilian casualties in June 2018 for injured patients with hemorrhagic shock and at least one of the following: systolic blood pressure <90 mm Hg, heart rate >130 beats/min, deterioration of consciousness without head injury or hemoglobin concentration ≤7 g/dL. Method: All casualties treated with LTOWB by IDF-CSAR providers from June 2018 to January 2021 were included. Demographic and prehospital treatment data were collected in order to check compliance and adherence to the IDF-MC guidelines. This is a follow-up retrospective report. Results: Overall, 1,608 LTOWB units were supplied to the IDF-CSAR during the study period. Of these, 33 were transfused to 27 casualties; 17 (69%) with blunt injury, 8 (29.6%) with penetrating injuries, and 1 (3.7%) with gastrointestinal bleeding without trauma. The leading cause of injury was motor vehicle accidents. A total of 23 casualties received 1 unit of LTOWB, 3 received 2 units and 1 patient received 4 units. Two casualties were children. The median heart rate was 120 beats/min, 8 (29.6%) casualties had heart rates >130 beats/min. Median systolic blood pressure was 95 mm Hg, 7 (26%) casualties had blood pressure <90 mm Hg. The median Glasgow Coma Score was 14. No adverse reactions were documented following the administration of LTOWB. 77.8% of patients received LTOWB in adherence to the guidelines. Conclusion: Appropriate administration of LTOWB has improved over time in IDF-CSAR. Using LTOWB is feasible and simpler than administering packed red blood cells and plasma concurrently. Further efforts are needed to introduce LTOWB in other prehospital and in-hospital scenarios, with an increase in the maximum antibody titer threshold, to meet the expected increase in demand.

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Section: Discussionsupporting

confidence: 89%

Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years’ Experience

Levin

Zur

Shinar

et al. 2021

Transfus Med Hemother

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“…Although we await the results of ongoing and future randomized controlled trials, recent meta-analyses of a randomized control trial, several retrospective, and prospective cohort studies with comparison groups found no increase in mortality resulting from whole blood use in injured patients [9,10]. Most of these studies were performed in military settings, limiting their generalizability to whole blood use in the civilian population.…”

Section: Noninferiority Of Low-titer Group O Whole Blood To Component...mentioning

confidence: 99%

Whole blood use in trauma resuscitation: targeting prehospital transfusion

Rangrass

2022

Current Opinion in Anaesthesiology

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Purpose of reviewTrauma resuscitation management has evolved over the years with a more nuanced understanding of the injured patient's physiologic state of shock. The purpose of this review is to discuss the role of whole blood administration in the prehospital setting in the resuscitation of the trauma patient. Recent findingsIn traumatically injured patients, whole blood administration initiated in the prehospital setting may improve early shock severity, coagulopathy, and survival when used over traditional resuscitation fluids such as crystalloid administration or component therapy.

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“…An aggressive balanced resuscitation strategy (1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelet concentrates) was incorporated into our algorithm for severe pelvic fracture–related hemorrhage in 1999 and was associated with a reduction in mortality from 30% to 15% [ 8 ]. Whole blood appears to be a safe alternative with theoretical advantages compared with 1:1:1 component therapy, but whole blood is less abundant and data do not show clear superiority [ 9 ]. The use of viscoelastic assays to guide blood product administration appears to be superior to "standard" coagulation tests, with an improvement in survival as well as lower blood product usage overall [ 10 ].…”

Section: Hemorrhage Controlmentioning

confidence: 99%

Control of pelvic fracture–related hemorrhage

Biffl

2022

Surgery Open Science

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Effectiveness and safety of whole blood compared to balanced blood components in resuscitation of hemorrhaging trauma patients - A systematic review

Cited by 42 publications

References 34 publications

Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years’ Experience

Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years’ Experience

Whole blood use in trauma resuscitation: targeting prehospital transfusion

Control of pelvic fracture–related hemorrhage

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