Prehospital whole blood reduces early mortality in patients with hemorrhagic shock

Abstract

Background Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion. Study design and methods A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6‐h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed. Results A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (−0.28 vs. −0.002, p < .001). In a propensity‐matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found (p > .05). Discussion This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi‐institutional prospective studies are needed.

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

“…Si el tiempo entre la lesión y el inicio de la transfusión es menor, la probabilidad de supervivencia puede aumentar en el paciente traumatizado 24,25 . Este hallazgo también se ha empezado a observar en las medidas de resucitación prehospitalarias con el uso de sangre total con bajos títulos de sangre O positivo, donde a pesar de que los pacientes tuvieran un peor estado fisiológico, la mortalidad fue menor, en comparación con los pacientes no transfundidos 26 .…”

Administration of blood products in the prehospital setting can decrease trauma patient mortality

“…A single-center, retrospective study was conducted to determine if prehospital administration LTOWB administration offers a survival benefit compared to saline in trauma patients. 5 Among the recipients of one unit of LTOWB in the prehospital phase of the resuscitation, no survival benefit was seen in the emergency department or at 6 and 24 h post injury compared to those who did not receive prehospital transfusion. However, in a propensity matched analysis of patients with prehospital shock, the LTOWB recipients had significantly fewer deaths in the emergency department compared to patients who did not receive prehospital transfusions and lower, but not significantly lower, rates of death at 6 and 24 h (19% and 26% reductions, respectively).…”

“…Its use is increasing at Level 1 trauma centers in the United States. A single‐center, retrospective study was conducted to determine if prehospital administration LTOWB administration offers a survival benefit compared to saline in trauma patients 5 . Among the recipients of one unit of LTOWB in the prehospital phase of the resuscitation, no survival benefit was seen in the emergency department or at 6 and 24 h post injury compared to those who did not receive prehospital transfusion.…”

The Role of Whole Blood Transfusions in Civilian Trauma: A Review of Literature in Military and Civilian Trauma

“…Braverman et al (2021) investigated a single institutional trauma registry for outcomes of patients based on prehospital transfusion (PHT) of LTOWB (n=107) vs. no transfusion (NT) (n=431) [ 30 ]. Among many outcomes, they found no statistically significant difference in 24-hour death (p=0.6) or all mortality (p=0.25).…”