Survey of group A plasma and low‐titer group O whole blood use in trauma resuscitation at adult civilian level 1 trauma centers in the US

Abstract

Background Recently revisited products like low‐titer group O whole blood (LTOWB) and novel applications of group A as a universal donor of plasma are being used for trauma resuscitation. A survey of American Level 1 trauma centers was performed to elucidate the extent to which these products are currently employed. Methods A survey was written that probed into the current use of blood products in trauma resuscitation with specific emphasis on LTOWB and group A plasma. A list of adult civilian Level 1 trauma centers in the continental USA was obtained from two public surgery and trauma focused websites. An email was then sent to each center's transfusion service medical director or laboratory manager providing them with a link to the online survey. Results Responses were received from 103/187 (55%) adult civilian Level 1 trauma centers. For the resuscitation of trauma patients, group A plasma was used at 94/103 (91%) centers, while LTOWB was used at 43/103 (42%) centers. There were 39/103 (38%) centers that used both products. At 62/94 (66%) of the centers that used group A plasma, there was no limit on the number of units that could be administered, while an unlimited number of LTOWB units could be used at 5/43 (12%) of the centers that used LTOWB. RhD‐positive LTOWB could be transfused to RhD‐negative or RhD‐type unknown females of childbearing potential at 22/43 (51%) of centers. Conclusion The use of group A plasma and LTOWB in trauma is increasing at American Level 1 trauma centers.

Prehospital Whole Blood Transfusion Programs in Norway

“…Initial protocols for cold-stored LTOWB were initiated to support the Norwegian Armed Forces with trauma resuscitation in international operations in 2013. This development seems to be consistent with the increasing implementation of cold-stored LTOWB in civilian systems in other countries [29, 30].…”

The rebirth of the cool: a narrative review of the clinical outcomes of cold stored low titer group O whole blood recipients compared to conventional component recipients in trauma

“…Neither study found an increased risk of mortality amongst the recipients of incompatible plasma compared with the recipients of compatible (or ABO-identical) plasma, although neither of these studies investigated whether hemolysis had occurred. In fact, 91% of the surveyed American level 1 trauma centers use group A plasma in the initial resuscitation of trauma patients whose ABO group is likely to be unknown at the time of the transfusion [17]. Overall, the evidence suggests that the transfusion of incompatible plasma does not cause hemolysis or lead to increased mortality amongst trauma patients.…”

“…Given these advantages over conventional components, it is not surprising that the use of LTOWB is increasing in the US [14][15][16][17][18][19] and around the world [20][21][22] for the resuscitation of bleeding civilian trauma patients. At the same time, data are accumulating about the clinical outcomes of patients who were resuscitated with LTOWB, although ongoing randomized trials have yet to be reported (see below) [23].…”

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

“…Restoration of adequate blood volume and correction of trauma-induced defects in hemostasis can be accomplished with transfusion of low titer (anti-A antibodies, anti-B antibodies < 1:256), type O, Rh-negative, whole blood (LTOWB). The use of LTOWB for trauma patients has expanded substantially in U.S level 1 and 2 trauma centers from 2018 to 2020, which includes an increase in the use of Rh-positive LTOWB in females of child-bearing years [ 117 , 118 ]. Benefits of LTOWB-based resuscitation include possibly an increase in survival compared to component-based resuscitation [ 119 , 120 ], reduced donor exposure, all elements critical to hemorrhage control are contained in one product in physiologic amounts [ 118 ], and that transfusion of younger red blood cells occurs [ 119 ] because of shorter storage times.…”

“…Conversely, other data suggest that, although safe, resuscitation with LTOWB does not significantly improve survival compare to component-based resuscitation [ 127 , 128 ], and LTOWB does not reduce blood product utilization, as first hypothesized [ 120 ]. Arguably, existing studies on LTOWB-based resuscitation are limited for the most part, and a more rigorous, high quality investigation to address the effectiveness of LTOWB may be warranted [ 117 , 119 , 129 ].…”