In silico model of the dilutional effects of conventional component therapy versus whole blood in the management of massively bleeding adult trauma patients

Seheult, Jansen N.; Stram, Michelle N.; Sperry, Jason L.; Spinella, Philip C.; Triulzi, Darrell J.; Yazer, Mark H.

doi:10.1111/trf.14983

Cited by 17 publications

(13 citation statements)

References 51 publications

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“…It is noteworthy that other conceptual mathematical models have generated accurate analyses of clinical issues in transfusion medicine and therapeutic apheresis with similar assumptions. [8][9][10][11][20][21][22][23][24][25][26][27][28][29][30]…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, assessing any detrimental clinical impacts of recirculation as a function of vascular access configuration in tandem ECMO and TPE may also be simultaneously addressed, though this would require a much larger study with a more restricted study population. It is noteworthy that other conceptual mathematical models have generated accurate analyses of clinical issues in transfusion medicine and therapeutic apheresis with similar assumptions 8‐11,20‐30 …”

Section: Discussionmentioning

confidence: 99%

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Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

Puelz

Marinaro

Park

et al. 2020

J of Clinical Apheresis

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Vascular access connection configurations during tandem extracorporeal membrane oxygenation (ECMO) and therapeutic plasma exchange (TPE) may impact exchange kinetics. In these tandem procedures, typically the TPE inlet line is proximal to the TPE return line with respect to blood flow in the ECMO device, maximizing the opportunity for replacement fluid homogenization within the ECMO circuit. However, if TPE inlet and return line connections are switched, recirculation-a phenomenon in which replacement fluid leaving the TPE return line is prematurely drawn into the TPE inlet line prior to satisfactory homogenization within the ECMO circuit-will occur. Such recirculation could diminish TPE efficacy in patients on ECMO and mitigate therapeutic benefits. Using a mathematical model of recirculation in tandem ECMO and TPE, we demonstrate that the predicted impact of recirculation is negligible and vascular access connection positioning does not appear to be a point of clinical concern with regard to TPE kinetics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

Puelz

Marinaro

Park

et al. 2020

J of Clinical Apheresis

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“…[17][18][19] Providing sufficient hemoglobin concentration by reducing hemodilution is an argument for whole blood, as the volume of additive solutions is higher in a component-based strategy than in whole blood. [20][21][22] In this publication, we describe our whole blood program and report our experience from the first years of routine use of whole blood as the primary blood product for resuscitation of massive hemorrhage, aiming to provide information relevant for other hospitals considering implementation of a whole blood program.…”

Section: Introductionmentioning

confidence: 99%

A whole blood based resuscitation strategy in civilian medical services: Experience from a Norwegian hospital in the period 2017–2020

et al. 2021

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Background Civilian and military guidelines recommend early balanced transfusion to patients with life‐threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. Study design and methods Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post‐transfusion blood samples were collected to analyze isohemagglutinin (anti‐A/‐B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. Results Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1–35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non‐group O. Haptoglobin level was lower in the transfusion episodes for non‐O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion‐associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. Discussion The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in‐hospital treatment of bleeding.

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“…Transfusion of whole blood has the advantage of providing a more concentrated resuscitation fluid as smaller volumes of preservatives and additive solutions are needed when compared to componentbased reconstituted whole blood. 15 Another logistical advantage is that 1 unit of whole blood is contained in one bag, which lessens the workload for the end user and requires only one temperature chain for transport. Studies suggest that whole blood-based resuscitation is at least equivalent to, if not more effective than, component-based therapy.…”

mentioning

confidence: 99%

“…Whole blood can be stored longer than platelet concentrates, which makes it an alternative solution for balanced transfusion to patients with major hemorrhage in hospitals unable to maintain a sufficient inventory of platelet concentrates. Transfusion of whole blood has the advantage of providing a more concentrated resuscitation fluid as smaller volumes of preservatives and additive solutions are needed when compared to component‐based reconstituted whole blood 15 . Another logistical advantage is that 1 unit of whole blood is contained in one bag, which lessens the workload for the end user and requires only one temperature chain for transport.…”

mentioning

confidence: 99%

How do I implement a whole blood–based blood preparedness program in a small rural hospital?

et al. 2020

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Civilian and military guidelines recommend balanced transfusion to patients with life-threatening bleeding. Early start of transfusion has shown improved survival. Thus, a balanced blood inventory must be available in all levels of health care to ensure early stabilization and damage control resuscitation of patients with bleeding. Whole blood has been reintroduced as a blood product for massive bleeding situations because it affords plasma, red blood cells, and platelets in a balanced ratio in a logistically advantageous way. In this article, we describe how to establish a whole blood-based blood preparedness program in a small rural hospital with limited resources. We present an implementation tool kit, which includes discussions on whole blood program strategies and the process of developing detailed procedures on donor selection, collection, storage, and transfusion management of whole blood. The importance of training and audit of the routines is highlighted, and establishment of an emergency walking blood bank is discussed. We conclude that implementation of a whole blood program is achievable in small rural hospitals and recommend that rural health care facilities at all treatment levels enable early balanced transfusion for patients with life-threatening bleeding by establishing protocols for whole blood-based preparedness.

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In silico model of the dilutional effects of conventional component therapy versus whole blood in the management of massively bleeding adult trauma patients

Cited by 17 publications

References 51 publications

Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

A whole blood based resuscitation strategy in civilian medical services: Experience from a Norwegian hospital in the period 2017–2020

How do I implement a whole blood–based blood preparedness program in a small rural hospital?

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