Safety and efficacy of low-titer O whole blood resuscitation in a civilian level I trauma center

Bohan, Phillip M. Kemp; McCarthy, Patrick M.; Wall, Morgan E.; Adams, Alexandra; Chick, Robert C.; Forcum, Jason E; Radowsky, Jason S.; How, Remealle A; Sams, Valerie G.

doi:10.1097/ta.0000000000003289

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…The mortality was significantly lower in the military DoDTR population (23% vs 41%, P < 0.001). Military patients who survived had a discharge mean GCS of 14 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, 32 (32.7%) of them had a discharge GCS < 9.…”

Section: Resultsmentioning

confidence: 99%

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

et al. 2022

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Objective: The purpose of this study was to compare therapeutic strategies and outcomes, following isolated gunshot wounds of the head, between military and civilian populations. Background: Recent military conflicts introduced new concepts in trauma care, including aggressive surgical intervention in severe head trauma. Methods: This was a cohort-matched study, using the civilian Trauma Quality Improvement Program (TQIP) database of the American College of Surgeons (ACS) and the Department of Defense Trauma Registry (DoDTR), during the period 2013 to 2016. Included in the study were patients with isolated gunshots to the head. Exclusion criteria were dead on arrival, civilians transferred from other hospitals, and patients with major extracranial associated injuries (body area Abbreviated Injury Scale >3). Patients in the military database were propensity score–matched 1:3 with patients in the civilian database. Results: A total of 136 patients in the DoDTR database were matched for age, sex, year of injury, and head Abbreviated Injury Scale with 408 patients from TQIP. Utilization of blood products was significantly higher in the military population (P<0.001). In the military group, patients were significantly more likely to have intracranial pressure monitoring (17% vs 6%, P<0.001) and more likely to undergo craniotomy or craniectomy (34% vs 13%, P<0.001) than in the civilian group. Mortality in the military population was significantly lower (27% vs 38%, P=0.013). Conclusions: Military patients are more likely to receive blood products, have intracranial pressure monitoring and undergo craniectomy or craniotomy than their civilian counterparts after isolated head gunshot wounds. Mortality is significantly lower in the military population. Level of Evidence: Level III—therapeutic.

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Section: Resultsmentioning

confidence: 99%

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

et al. 2022

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“…In a retrospective review of a Level 1 Civilian Trauma Center Registry, Kemp Bohan et al (2021) reported no significant difference in 24-hour mortality when comparing WBT to BCT [ 27 ]. Two hundred sixteen patients admitted with hemorrhagic shock receiving blood products prehospital or within 24 hours were grouped into three cohorts receiving either WBT (n=34), BCT (n=95), or WBT plus BCT (n=87).…”

Section: Reviewmentioning

confidence: 99%

“…Two hundred sixteen patients admitted with hemorrhagic shock receiving blood products prehospital or within 24 hours were grouped into three cohorts receiving either WBT (n=34), BCT (n=95), or WBT plus BCT (n=87). There were no significant differences across the three study groups regarding mortality (p=0.45); however, at 30 days and during the hospital stay, mortality was higher in the WBT+BCT cohort vs. the WBT only and BCT groups; however, this was not shown to be statistically significant (p=0.05 and p=0.06, respectively) [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

“…Many studies referenced have low sample sizes, and the populations studied were primarily military casualties, which create limitations in the generalizability to typical civilian hospital systems and their populations. As noted in Kemp Bohan et al (2021), another consideration is potential differences in the survivability of the wounds between the WBT and BCT therapies [ 27 ]. Differences in injury severity could have impacted the observed mortality comparisons between the various cohorts.…”

Section: Reviewmentioning

confidence: 99%

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

Kronstedt¹,

Lee²,

Millner³

et al. 2022

Cureus

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Resuscitation techniques for the management of adult trauma patients have evolved over the 20th century. Whole blood transfusions were previously used as the standard of care, whereas blood component therapy is the current method employed across most trauma centers across the United States. Prior to the transition, no studies were conducted to show improved efficacy of hemostatic potential in trauma patients. Recent conflicts in Iraq and Afghanistan have challenged the dogma that whole blood transfusions are not the standard of care and have shown potential as the superior transfusion product for adult trauma patients. The purpose of this review is to provide a comprehensive review and elucidate if whole blood transfusions have a role in civilian trauma patients based upon recent military medical literature and civilian pilot studies using whole blood transfusions.

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“…In both groups, platelets were transfused first followed by plasma alternating with pRBCs. Components transfused 1:1:1 deliver a blood substitute that is anemic, thrombocytopenic and hypocoagulable [ 131 ].…”

Section: Management Of the Polytrauma Victimmentioning

confidence: 99%

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

Fecher

Stimpson

Ferrigno

et al. 2021

JCM

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The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders. Consequently, for every polytrauma victim with a significant mechanism of injury we assume substantial blood loss has occurred and life-threatening hemorrhage is progressing until we can prove the contrary. Second, a decision to begin damage control resuscitation (DCR), a costly, highly complex, and potentially dangerous intervention must often be reached with little time and without sufficient clinical information about the intended recipient. Whether to begin DCR in the prehospital phase remains controversial. Furthermore, DCR executed imperfectly has the potential to worsen serious derangements including acidosis, coagulopathy, and profound homeostatic imbalances that DCR is designed to correct. Additionally, transfusion of large amounts of homologous blood during DCR potentially disrupts immune and inflammatory systems, which may induce severe systemic autoinflammatory disease in the aftermath of DCR. Third, controversy remains over the composition of components that are transfused during DCR. For practical reasons, unmatched liquid plasma or freeze-dried plasma is transfused now more commonly than ABO-matched fresh frozen plasma. Low-titer type O whole blood may prove safer than red cell components, although maintaining an inventory of whole blood for possible massive transfusion during DCR creates significant challenges for blood banks. Lastly, as the primary principle of management of life-threatening hemorrhage is surgical or angiographic control of bleeding, DCR must not eclipse these definitive interventions.

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Safety and efficacy of low-titer O whole blood resuscitation in a civilian level I trauma center

Cited by 16 publications

References 21 publications

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

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

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

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