Quantifying the benefit of whole blood on mortality in trauma patients requiring emergent laparotomy.

BACKGROUND

Whole blood (WB) transfusions in trauma represent an increasingly utilized resuscitation strategy in trauma patients. Previous reports suggest a probable mortality benefit with incorporating WB into massive transfusion protocols. However, questions surrounding optimal WB practices persist. We sought to assess the association between the proportion of WB transfused during the initial resuscitative period and its impact on early mortality outcomes for traumatically injured patients.

METHODS

We performed a retrospective analysis of severely injured patients requiring emergent laparotomy and ≥ 3 units of red blood cell containing products (WB or packed red blood cells) within the first hour from an ACS Level 1 Trauma Center (2019-2022). Patients were evaluated based on the proportion of WB they received compared to packed red blood cells during their initial resuscitation (high ratio cohort ≥50% WB vs low ratio cohort <50% WB). Multilevel Bayesian regression analyses were performed to calculate the posterior probabilities and risk ratios (RR) associated with a WB predominant resuscitation for early mortality outcomes.

RESULTS

266 patients were analyzed (81% male, mean age of 36 years old, 61% penetrating injury, mean ISS of 30). The mortality was 11% at 4-hours and 14% at 24-hours. The high ratio cohort demonstrated a 99% (RR 0.12; 95% CrI 0.02-0.53) and 99% (RR 0.22; 95% CrI 0.08-0.65) probability of decreased mortality at 4-hours and 24-hours, respectively, compared the low ratio cohort. There was a 94% and 88% probability of at least a 50% mortality relative risk reduction associated with the WB predominate strategy at 4 hours and 24 hours, respectively.

CONCLUSION

Preferential transfusion of WB during the initial resuscitation demonstrated a 99% probability of being superior to component predominant resuscitations with regards to 4 and 24-hour mortality suggesting that WB predominant resuscitations may be superior for improving early mortality. Prospective, randomized trials should be sought.

LEVEL OF EVIDENCE

Therapeutic, Level III.

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.

Déclaration de conflit d'intérêts

Conflict of Interest: DL, RB, ME, JB, ZH, JJ all have grant funding support through the Department of Defense on unrelated research projects. JB has grant funding from ZOLL Foundation and MTEC on unrelated research projects. ZH has grant funding from NIMHD (awaiting notice of funding), UAB Faculty Development Grant Program, RevMedx, National highway Traffic Safety Administration on unrelated research projects. JH is a co-founder and on the Board of Directors of Decisio Health, on the Board of Directors of QinFlow and Zibria, a Co-inventor of the Junctional Emergency Tourniquet Tool, an adviser to Aspen Medical, and Wake Forest Institute of Regenerative Medicine. JJ also has unrelated grant funding from NHLBI, NIHR, MTEC, study support from CSL Behring, RevMedX, Infrascan, and is a consultant for CSL Behring, Infrascan, Cellphire, Octapharm. JB and JM are co-founders of the Behind The Knife Podcast. DL, RB, ME, JM, JB, EW are all active duty military members however the views in this paper are that of our own and do the reflect the views of the government or Department of Defense. JK is currently the ACS COT President. The remaining authors declare no conflicts of interest. All JTACS Disclosure forms have been supplied and are provided as supplemental digital content (http://links.lww.com/TA/D796).