Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients
Introduction Whole blood (WB) transfusion represents a promising resuscitation strategy for trauma patients. However, a paucity of data surrounding the optimal incorporation of WB into resuscitation strategies persists. We hypothesized that traumatically injured patients who received a greater propo...
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BMJ Publishing Group
2024-07-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001358.full |
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| author | John B Holcomb Jeffrey David Kerby Parker Hu Jan O Jansen Daniel Lammers Omar Rokayak Emily W Baird Richard D Betzold Zain Hashmi |
| author_facet | John B Holcomb Jeffrey David Kerby Parker Hu Jan O Jansen Daniel Lammers Omar Rokayak Emily W Baird Richard D Betzold Zain Hashmi |
| author_sort | John B Holcomb |
| collection | DOAJ |
| description | Introduction Whole blood (WB) transfusion represents a promising resuscitation strategy for trauma patients. However, a paucity of data surrounding the optimal incorporation of WB into resuscitation strategies persists. We hypothesized that traumatically injured patients who received a greater proportion of WB compared with blood product components during their resuscitative efforts would have improved early mortality outcomes and decreased transfusion requirements compared with those who received a greater proportion of blood product components.Methods Retrospective review from our Level 1 trauma center of trauma patients during their initial resuscitation (2019–2022) was performed. WB to packed red blood cell ratios (WB:RBC) were assigned to patients based on their respective blood product resuscitation at 1, 2, 3, and 24 hours from presentation. Multivariable regression models were constructed to assess the relationship of WB:RBC to 4 and 24-hour mortality, and 24-hour transfusion requirements.Results 390 patients were evaluated (79% male, median age of 33 years old, 48% penetrating injury rate, and a median Injury Severity Score of 27). Overall mortality at 4 hours was 9%, while 24-hour mortality was 12%. A significantly decreased 4-hour mortality was demonstrated in patients who displayed a WB:RBC≥1 at 1 hour (5.9% vs. 12.3%; OR 0.17, p=0.015), 2 hours (5.5% vs. 13%; OR 0.16, p=0.019), and 3 hours (5.5% vs. 13%, OR 0.18, p<0.01), while a decreased 24-hour mortality was displayed in those with a WB:RBC≥1 at 24 hours (7.9% vs. 14.6%, OR 0.21, p=0.01). Overall 24-hour transfusion requirements were significantly decreased within the WB:RBC≥1 cohort (12.1 units vs. 24.4 units, p<0.01).Conclusion Preferential WB transfusion compared with a balanced transfusion strategy during the early resuscitative period was associated with a lower 4 and 24-hour mortality, as well as decreased 24-hour transfusion requirements, in trauma patients. Future prospective studies are warranted to determine the optimal use of WB in trauma.Level of evidence Level III/therapeutic |
| format | Article |
| id | doaj-art-756028b6b3164342b37fb64af7d79f4d |
| institution | DOAJ |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-756028b6b3164342b37fb64af7d79f4d2025-08-20T03:11:39ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-07-019110.1136/tsaco-2023-001358Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patientsJohn B Holcomb0Jeffrey David Kerby1Parker Hu2Jan O Jansen3Daniel Lammers4Omar Rokayak5Emily W Baird6Richard D Betzold7Zain Hashmi8The University of Alabama at Birmingham, Birmingham, Alabama, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USADivision of Acute Care Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USASurgery, University of Alabama at Birmingham, Birmingham, Alabama, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USAIntroduction Whole blood (WB) transfusion represents a promising resuscitation strategy for trauma patients. However, a paucity of data surrounding the optimal incorporation of WB into resuscitation strategies persists. We hypothesized that traumatically injured patients who received a greater proportion of WB compared with blood product components during their resuscitative efforts would have improved early mortality outcomes and decreased transfusion requirements compared with those who received a greater proportion of blood product components.Methods Retrospective review from our Level 1 trauma center of trauma patients during their initial resuscitation (2019–2022) was performed. WB to packed red blood cell ratios (WB:RBC) were assigned to patients based on their respective blood product resuscitation at 1, 2, 3, and 24 hours from presentation. Multivariable regression models were constructed to assess the relationship of WB:RBC to 4 and 24-hour mortality, and 24-hour transfusion requirements.Results 390 patients were evaluated (79% male, median age of 33 years old, 48% penetrating injury rate, and a median Injury Severity Score of 27). Overall mortality at 4 hours was 9%, while 24-hour mortality was 12%. A significantly decreased 4-hour mortality was demonstrated in patients who displayed a WB:RBC≥1 at 1 hour (5.9% vs. 12.3%; OR 0.17, p=0.015), 2 hours (5.5% vs. 13%; OR 0.16, p=0.019), and 3 hours (5.5% vs. 13%, OR 0.18, p<0.01), while a decreased 24-hour mortality was displayed in those with a WB:RBC≥1 at 24 hours (7.9% vs. 14.6%, OR 0.21, p=0.01). Overall 24-hour transfusion requirements were significantly decreased within the WB:RBC≥1 cohort (12.1 units vs. 24.4 units, p<0.01).Conclusion Preferential WB transfusion compared with a balanced transfusion strategy during the early resuscitative period was associated with a lower 4 and 24-hour mortality, as well as decreased 24-hour transfusion requirements, in trauma patients. Future prospective studies are warranted to determine the optimal use of WB in trauma.Level of evidence Level III/therapeutichttps://tsaco.bmj.com/content/9/1/e001358.full |
| spellingShingle | John B Holcomb Jeffrey David Kerby Parker Hu Jan O Jansen Daniel Lammers Omar Rokayak Emily W Baird Richard D Betzold Zain Hashmi Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients Trauma Surgery & Acute Care Open |
| title | Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients |
| title_full | Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients |
| title_fullStr | Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients |
| title_full_unstemmed | Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients |
| title_short | Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients |
| title_sort | preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients |
| url | https://tsaco.bmj.com/content/9/1/e001358.full |
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