Whole Blood vs Blood Component Therapy for Transfusion in Trauma Patients: A Prospective, Multicenter Study
*Joshua P. Hazelton1, *Anna E. Ssentongo12, *John S. Oh1, *Paddy Ssentongo2, *Mark J. Seamon5, *James P. Byrne5, *Isabella G. Armento6, Donald H. Jenkins7, *Maxwell A. Braverman7, *Caleb Mentzer8, *Guy C. Leonard8, *Lindsey L. Perea9, *Courtney K. Docherty10, *Julie A. Dunn11, *Brittany Smoot11, *Matthew Martin12, *Jayraan Badiee12, *Alejandro J. Luis13, *Julie L. Murray14, *Matthew R. Noorbakhsh15, *James E. Babowice15, *Charles Mains16, *Robert Madayag16, *Haytham Kaafarani17, *Ava Mokhtari17, *Annie Moore18, *Kathleen Madden18, *Allen Tanner II19, *Diane Redmond19, *David J. Millia20, *Amber Brandolino20, *Uyen Nguyen3, *Vernon Chinchilli4, *Scott Armen21, *John Porter22
1Surgery, Penn State Health Milson S. Hershey Medical Center, Hershey, PA, 2NEURAL Center for Neural Engineering, Penn State University, University Park, PA, 3Penn State College of Medicine, Hershey, PA, 4Public Health Sciences, Penn State College Of Medicine, Hershey, PA, 5Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, 6Surgery, Cooper University Hospital, Camden, NJ, 7Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, 8Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, 9Surgery, Penn Medicine Lancaster General Hospital, Lancaster, PA, 10Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 11Surgery, UCHealth North Medical Center of the Rockies, Loveland, CO, 12Surgery, Scripps Mercy Hospital, San Diego, CA, 13Surgery, Palmetto Health USC, Columbia, SC, 14Prisma Health Richland, Columbia, SC, 15Surgery, Allegheny General Hospital, Pittsburgh, PA, 16Surgery, St. Anthony Hospital, Loveland, CO, 17Surgery, Massachusetts General Hospital, Boston, MA, 18University of New Mexico, Albuquerque, NM, 19Penrose St. Francis Health Services, Colorado Springs, CO, 20Medical College of Wisconsin, Milwaukee, WI, 21Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 22Cooper University Hospital, Camden, NJ
Objective: Currently, blood component therapy (BCT) is standard practice for the resuscitation of trauma patients, but recently whole blood (WB) transfusion has emerged as the resuscitation strategy of choice at select US trauma centers. Much of the data regarding WB is limited to small prospective or retrospective studies which have failed to demonstrate a significant benefit of WB versus BCT. We hypothesized that the use of WB transfusion vs BCT alone would result in decreased mortality in trauma patients. Methods: We performed a multicenter (14 verified trauma centers), prospective-observational study of patients who received WB vs BCT during their initial trauma resuscitation. We applied a generalized linear mixed-effects model with a random effect (to control for center) and also controlled for age, sex, mechanism of injury (MOI) and injury severity score (ISS). Trauma patients of any age who received a blood transfusion as part of their initial resuscitation were included. Primary outcome was in-hospital mortality and secondary outcomes included acute kidney injury (AKI), deep venous thrombosis (DVT), pulmonary complications, bleeding complications, and length of stay (LOS). Results: A total of 1,623 trauma patients who sustained either penetrating (53%) or blunt (47%) injury were included. Of the 1,623 patients, 1,180 (73%) received at least one unit of WB while 443 (27%) received only BCT. Median age was 40y (IQR 11-30), 83% were male and median ISS was 22 (IQR 11-30). Patients who received WB had a higher shock index (1.08 vs 0.94), more comorbid conditions, and more likely had a blunt MOI (all p<0.05). After controlling for center, age, sex, prehospital blood products, MOI, and ISS, we found no differences in the rates of AKI, DVT/PE, pulmonary complications, or LOS between groups. Patients who received WB were 9% less likely to experience a bleeding complication and were 48% less likely to die than those who received BCT alone (p<0.0001) [Figure]. Conclusions: Compared with standard blood component therapy, the use of whole blood transfusion resulted in a 48% reduction in mortality in trauma patients. Our study supports the universal use of whole blood during the initial resuscitation of trauma patients who require a transfusion.
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