The use of low‐titer group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage

Abstract

BACKGROUND There is a resurgence in the use of low‐titer group O whole blood (LTOWB) for hemorrhagic shock. We hypothesized the use of LTOWB compared to component therapy (CT) would be independently associated with improved 24‐hour mortality. STUDY DESIGN AND METHODS In this prospective observational study, trauma patients 18 years of age or older with massive transfusion protocol activations were included from August 17, 2018, to May 14, 2019. The primary outcome was 24‐hour mortality. Secondary outcomes included 72‐hour blood product totals, multiple organ dysfunction scores (MODS), and 28‐day mortality. Multivariable logistic regression (MVLR) and Cox regression were performed to determine independent associations. RESULTS There were no clinically meaningful differences in measures of injury severity between study groups (CT, n = 42; LTOWB, n = 44). There was no difference in MODS between study groups. The unadjusted mortality was not statistically different between the study groups (9/42 [21%] for CT vs. 7/44 [16%] for LTOWB; p = 0.518). In the MVLR model, LTOWB increased the odds of 24‐hour survival by 23% (odds ratio 0.81, 95% confidence interval 0.69‐0.96; p = 0.017). Adjusted survival curve analysis indicated improved survival at both 24 hours and 28 days for LTOWB patients (p < 0.001). Further stratification showed an association between LTOWB use and survival when maximum clot firmness (MCF) was 60 mm or less (p = 0.009). CONCLUSIONS The use of LTOWB is independently associated with improved 24‐hour and 28‐day survival, and does not increase organ dysfunction at 72 hours. Use of LTOWB most impacted survival of patients with reduced clot firmness (MCF ≤60 mm). Collectively, these data support the clinical use and continued study of LTOWB for hemostatic resuscitation.

The use of low‐titer group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage

“…We read with interest the analysis by Moore et al addressing the impact of sample time of secondary bacterial culture to the risk of exposure to a bacterially contaminated platelet. 1 The authors conclude that "sampling earlier in the specified secondary culture windows may be most optimal for safety". Their analysis is based on their stated premise that there is a 24-h window in which the secondary culture sample can be taken.…”

Re‐introducing whole blood for transfusion: considerations for blood providers

“…Studies are needed to understand the clinical and logistical benefits that whole blood may bring compared to component therapy, to define what patient populations might most benefit from WB and to define the maximal number of units that might safely be transfused before switching to component therapy. Recent observational studies suggest a benefit of whole blood [56, 57], but there is a need for well designed randomized trials to address these questions.…”

Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

“…Since then, the paucity of literature mostly constitutes editorials or papers on the feasibility of applying far forward combat WB use to the civilian arena. A total of 1382 civilian patients form the foundation of WB’s widespread adoption in the United States’ urban areas [ 1 , 2 , 3 , 4 , 5 , 6 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The most recent small studies revealed an equivocal mortality benefit from overuse of WB because “it was easier and faster in a chaotic and busy trauma bay” [ 29 ].…”