Over‐transfusion with blood for suspected hemorrhagic shock is not associated with worse clinical outcomes

Abstract

Background We evaluated patient outcomes after early, small volume red blood cell (RBC) transfusion in the setting of presumed hemorrhagic shock. We hypothesized that transfusion with even small amounts of blood would be associated with more complications. Study design and methods Retrospective review of trauma patients admitted to a Level 1 trauma center between 2016–2021. Patients predicted to require massive transfusion who survived ≥72 h were categorized according to units of RBCs transfused in the first 24 h. A Cox regression model stratified by dichotomized ISS and adjusted for SBP <90 mm Hg and pulse >120 bpm on arrival was used to estimate hazard ratios (HRs) for outcomes of interest. Results A total of 3121 (24%) received RBC transfusion within the first 24 h. Massive transfusion protocol (MTP) was activated in 38% (1188/3121): 17% received no RBCs, 27.4% 1–3 units, 32.4% 4–9 units, and 22.7% ≥10 units. Mean ISS increased with each category of RBC transfusion. There was no difference in the risk of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), infection, cardiac arrest, venous thromboembolism or stroke for patients receiving 1–3 units compared to the non‐transfused group or 4–9 units group (p > 0.05). Compared to those receiving ≥10 units, the 1–3 units group had a significantly lower risk of AKI, ARDS, and cardiac arrest. Discussion Early empiric RBC transfusion for presumed hemorrhagic shock may subject patients to potential over‐transfusion and end‐organ damage. Among patients meeting clinical triggers for MTP, 1–3 units of allogeneic RBCs is not associated with worse outcomes.

Carbazochrome sodium sulfonate and tranexamic acid combination therapy to reduce blood transfusions after 24 h of injury: A retrospective study

“…In the current study, other CSS‐related effects were expected, including a reduced incidence of complications associated with acute kidney injury, 1 , 16 acute respiratory distress syndrome, and lung edema. 1 , 2 , 17 , 18 However, the incidence of these complications was not reduced in the CSS + TXA group; this observation could be attributed to the small sample size.…”

“…Reducing the required blood transfusion volume using drug treatments can reduce exposure to allogeneic blood products and limit the unnecessary use of medical resources. 1 , 2 …”

Dynamic structures and emerging trends in the management of major trauma: A bibliometric analysis of publications between 2012 and 2021

“…These two authors have been extensively involved in the clinical research of severe trauma, such as whole-body CT in polytrauma ( 31 ), the administration of tranexamic acid and fibrinogen concentrate in patients with trauma ( 32 , 33 ), intracranial pressure monitoring in severe head injury ( 34 ), massive transfusion protocol ( 35 ), and emergency operation ( 36 ). Holcomb JB from the University of Alabama at Birmingham received the most co-citations (201 citations) and is active in the field of severe trauma research ( 37 – 39 ).…”

Damage control resuscitation in adult trauma patients: What you need to know

“…Blood product components or LTO + WB via the ED Quick Pack are transfused at the earliest time possible. Our goal and resuscitative focus for all traumatically injured patients is to initiate blood-based resuscitation as soon as possible with the goal of completely eliminating any crystalloid use for patients in suspected hemorrhagic shock 76 . We prefer to use LTO + WB for the presumed sickest patients in efforts to limit this resource to the patients that we believe may benefit the most from it.…”

“…Our goal and resuscitative focus for all traumatically injured patients is to initiate blood-based resuscitation as soon as possible with the goal of completely eliminating any crystalloid use for patients in suspected hemorrhagic shock. 76 We prefer to use LTO + WB for the presumed sickest patients in efforts to limit this resource to the patients that we believe may benefit the most from it. In addition, we endorse the principles of hypotensive resuscitation, targeting a systolic blood pressure no greater than 90 mm Hg and appropriate mentation, when clinically feasible.…”