Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients

Daniel Lammers; Parker Hu; Omar Rokayak; Emily W Baird; Richard D Betzold; Zain Hashmi; Jeffrey David Kerby; Jan O Jansen; John B Holcomb

doi:10.1136/tsaco-2023-001358

Preferential whole blood transfusion during the early resuscitation period is associated with decreased mortality and transfusion requirements in traumatically injured patients

Trauma Surg Acute Care Open. 2024 Apr 22;9(1):e001358. doi: 10.1136/tsaco-2023-001358. eCollection 2024.

Authors

Daniel Lammers¹, Parker Hu¹, Omar Rokayak¹, Emily W Baird¹, Richard D Betzold¹, Zain Hashmi¹, Jeffrey David Kerby¹, Jan O Jansen¹, John B Holcomb¹

Affiliation

¹ The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Abstract

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.

Keywords: Whole blood; hemorrhagic shock; resuscitation.