Ander Dorken-Gallastegi, Phillip C Spinella, Matthew D Neal, Christine Leeper, Jason Sperry, Andrew B Peitzman, Joshua B Brown
{"title":"Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association With Mortality.","authors":"Ander Dorken-Gallastegi, Phillip C Spinella, Matthew D Neal, Christine Leeper, Jason Sperry, Andrew B Peitzman, Joshua B Brown","doi":"10.1097/SLA.0000000000006316","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the interaction between whole blood (WB) and blood component resuscitation in relation to mortality after trauma.</p><p><strong>Background: </strong>WB is increasingly available in civilian trauma resuscitation, and it is typically transfused concomitantly with blood components. The interaction between WB and blood component transfusions is unclear.</p><p><strong>Methods: </strong>Adult patients with trauma with a shock index >1 who received ≥4 combined units of red blood cells and/or WB within 4 hours across 501 U.S. trauma centers were included using the American College of Surgeons Trauma Quality Improvement Program database. The associations between (1) WB resuscitation and mortality, (2) WB to total transfusion volume ratio (WB:TTV) and mortality, and (3) balanced blood component transfusion in the setting of combined WB and component resuscitation and mortality were evaluated with multivariable analysis.</p><p><strong>Results: </strong>A total of 12,275 patients were included (WB: 2884 vs component-only: 9391). WB resuscitation was associated with lower odds of 4-hour [adjusted odds ratio: 0.81 (0.68-0.97)], 24-hour, and 30-day mortality compared with component-only. Higher WB:TTV ratios were significantly associated with lower 4-hour, 24-hour, and 30-day mortality, with a 13% decrease in odds of 4-hour mortality for each 10% increase in the WB:TTV ratio [0.87 (95% CI: 0.80-0.94)]. Balanced blood component transfusion was associated with significantly lower odds of 4-hour [adjusted odds ratio: 0.45 (95% CI: 0.29-0.68)], 24-hour, and 30-day mortality in the setting of combined WB and blood component resuscitation.</p><p><strong>Conclusions: </strong>WB resuscitation, higher WB:TTV ratios, and balanced blood component transfusion in conjunction with WB were associated with lower mortality in patients with trauma presenting in shock requiring at least 4 units of red blood cells and/or WB transfusion within 4 hours of arrival.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538373/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLA.0000000000006316","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To evaluate the interaction between whole blood (WB) and blood component resuscitation in relation to mortality after trauma.
Background: WB is increasingly available in civilian trauma resuscitation, and it is typically transfused concomitantly with blood components. The interaction between WB and blood component transfusions is unclear.
Methods: Adult patients with trauma with a shock index >1 who received ≥4 combined units of red blood cells and/or WB within 4 hours across 501 U.S. trauma centers were included using the American College of Surgeons Trauma Quality Improvement Program database. The associations between (1) WB resuscitation and mortality, (2) WB to total transfusion volume ratio (WB:TTV) and mortality, and (3) balanced blood component transfusion in the setting of combined WB and component resuscitation and mortality were evaluated with multivariable analysis.
Results: A total of 12,275 patients were included (WB: 2884 vs component-only: 9391). WB resuscitation was associated with lower odds of 4-hour [adjusted odds ratio: 0.81 (0.68-0.97)], 24-hour, and 30-day mortality compared with component-only. Higher WB:TTV ratios were significantly associated with lower 4-hour, 24-hour, and 30-day mortality, with a 13% decrease in odds of 4-hour mortality for each 10% increase in the WB:TTV ratio [0.87 (95% CI: 0.80-0.94)]. Balanced blood component transfusion was associated with significantly lower odds of 4-hour [adjusted odds ratio: 0.45 (95% CI: 0.29-0.68)], 24-hour, and 30-day mortality in the setting of combined WB and blood component resuscitation.
Conclusions: WB resuscitation, higher WB:TTV ratios, and balanced blood component transfusion in conjunction with WB were associated with lower mortality in patients with trauma presenting in shock requiring at least 4 units of red blood cells and/or WB transfusion within 4 hours of arrival.
期刊介绍:
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.