Zero preventable deaths after traumatic injury

Spinella, Philip C.

doi:10.1097/ta.0000000000001425

Cited by 52 publications

(55 citation statements)

References 16 publications

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“…Trauma is a leading cause of death worldwide, with as many as 40% of trauma‐associated mortalities resulting from hemorrhage . In the United States, approximately 30,000 annual traumatic hemorrhagic shock deaths are estimated to be preventable after injury due to untimely or inadequate care . To address the high rate of death from hemorrhage, there has been a resurgence in the use of low‐titer group O whole blood (LTOWB) for hemostatic resuscitation due to its increased potency, safety, and logistical benefits compared to component therapy (CT) .…”

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confidence: 99%

“…In addition, the use of only one bag of LTOWB over the multiple bags and vascular access points needed with CT simplifies the logistics of transfusion, resulting in more rapid administration of therapy in the field and at the bedside, potentially improving outcomes in a situation where every minute counts . This logistic benefit of LTOWB is pronounced in the prehospital phase of resuscitation, where deaths from hemorrhage are most common …”

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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

et al. 2020

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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.

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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

et al. 2020

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“…There are roughly 30,000 preventable civilian deaths from hemorrhagic shock after traumatic injury per year in the United States (US) . Currently, most civilian trauma patients in the US will be resuscitated using component therapy.…”

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confidence: 99%

“…T here are roughly 30,000 preventable civilian deaths from hemorrhagic shock after traumatic injury per year in the United States (US). 1 Currently, most civilian trauma patients in the US will be resuscitated using component therapy. However, there has been increasing use of cold-stored, low-titer anti-A and anti-B, group O whole blood (LTOWB) to resuscitate patients with hemorrhagic shock.…”

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confidence: 99%

Effect of leukoreduction and pathogen reduction on the hemostatic function of whole blood

et al. 2019

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BACKGROUND There is renewed interest in the use of whole blood (WB) for resuscitation of patients in hemorrhagic shock. Leukoreduction with platelet‐sparing filters and pathogen reduction may be used to improve the safety profile of WB, yet the effects of leukoreduction and pathogen reduction on WB hemostatic function are not well characterized. STUDY DESIGN AND METHODS Blood from 32 healthy group O donors was divided into treatment groups (n = 8 for each group): untreated, pathogen reduced (PR+), leukoreduced using an in‐line filter (LR+), or PR+LR+. Units were stored without agitation for 21 days between 1° and 6°C, with sampling on days 0 (pre‐ and post‐treatments), 1, 3, 5, 10, 15, and 21 for hemostatic function as assessed by thromboelastometry, thrombin generation, platelet activation factors, and platelet impedance aggregometry. RESULTS From day 3 (D3) to D15 of storage, platelet count was reduced in PR+/LR+ units compared to PR−/LR− units. From D10 to D21 of storage, maximum clot firmness (MCF) was reduced in PR+/LR+ units compared to PR−/LR− units. From D3 to D21 of storage, platelet aggregation was reduced in PR+/LR+ units compared to PR−/LR− units. Total thrombin generation was similar in all groups from D0 to D21. CONCLUSIONS The combination of LR with a platelet‐sparing filter and PR significantly reduces hemostatic function compared to either treatment alone or untreated WB. The clinical consequences of LR and PR of WB in patients with severe bleeding should be examined in trials before both are used in combination in patients.

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“…The most common cause of preventable deaths after traumatic injury is severe bleeding . There are an estimated 30,000 preventable deaths due to traumatic bleeding per year in the United States . Traumatic injury is also the most common cause of death for people between 1 and 46 years of age, and trauma also accounts for the most years of life lost until the age of 75 .…”

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confidence: 99%

Agglutination testing for human erythrocyte product in the rhesus macaque

et al. 2019

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INTRODUCTION There has been interest in using human blood products in nonhuman primate models of trauma to supplement human studies and to provide evidence to guide novel trauma resuscitation strategies. The compatibility of human RBCs has not been extensively studied in nonhuman primate species. METHODS Whole blood samples were collected from five healthy, nontransfused, not previously pregnant Chinese‐bred rhesus macaques. The whole blood was centrifuged, and the plasma was decanted from each sample. Group O‐negative human RBCs were mixed with the plasma from the rhesus macaque monkeys. Compatibility testing was performed by an immediate spin test and polyspecific and monospecific anti‐human globulin (AHG) tests in glass tubes. RESULTS Immediate spin testing revealed three out of five plasma samples (60%) from rhesus macaques caused at least 1+ agglutination with the human RBCs. Polyspecific anti‐human globulin (AHG) tests demonstrated that two of five plasma samples (40%) from rhesus macaques caused at least 1+ agglutination with the human RBC, while the monospecific AHG testing revealed that the incompatibility was caused by C3d, not IgG. CONCLUSION Human RBCs are not compatible with the plasma of some, but not all, Chinese‐bred rhesus macaques.

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Zero preventable deaths after traumatic injury

Cited by 52 publications

References 16 publications

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

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

Effect of leukoreduction and pathogen reduction on the hemostatic function of whole blood

Agglutination testing for human erythrocyte product in the rhesus macaque

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