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

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2024-11-01 Epub Date: 2024-05-01 DOI:10.1097/TA.0000000000004382

Daniel Lammers, Richard Betzold, John McClellan, Matthew Eckert, Jason Bingham, Parker Hu, Stuart Hurst, Emily Baird, Zain Hashmi, Jeffrey Kerby, Jan O Jansen, John B Holcomb

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Abstract

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 I Trauma Center (2019-2022). Patients were evaluated based on the proportion of WB they received compared with 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: Two hundred sixty-six patients were analyzed (81% male; mean age, 36 years; 61% penetrating injury; mean Injury Severity Score, 30). The mortality was 11% at 4 hours and 14% at 24 hours. The high ratio cohort demonstrated a 99% (RR, 0.12; 95% credible interval, 0.02-0.53) and 99% (RR, 0.22; 95% credible interval, 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-hour 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/Care Management; Level IV.

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量化全血对需要紧急开腹手术的外伤患者死亡率的益处。

背景：创伤中的全血（WB）输注是创伤患者越来越常用的复苏策略。以往的报告显示，将全血纳入大量输血方案可能会降低死亡率。然而，围绕最佳 WB 实践的问题依然存在。我们试图评估创伤患者在复苏初期输注 WB 的比例与其对早期死亡率结果的影响之间的关联：我们对来自 ACS 一级创伤中心（2019-2022 年）、需要紧急开腹手术且在第一小时内输注≥ 3 个单位含红细胞产品（WB 或包装红细胞）的重伤患者进行了回顾性分析。根据患者在初始复苏期间接受的 WB 与包装红细胞的比例对其进行评估（高比例队列≥50% WB vs 低比例队列）结果：分析了 266 名患者（81% 为男性，平均年龄为 36 岁，61% 为穿透性损伤，平均 ISS 为 30）。4 小时死亡率为 11%，24 小时死亡率为 14%。与低比率队列相比，高比率队列在 4 小时和 24 小时内的死亡率分别降低了 99% (RR 0.12; 95% CrI 0.02-0.53) 和 99% (RR 0.22; 95% CrI 0.08-0.65)。在 4 小时和 24 小时内，以白细胞为主的策略分别有 94% 和 88% 的概率使死亡率相对风险降低至少 50%：结论：就 4 小时和 24 小时死亡率而言，初始复苏期间优先输注白细胞的概率为 99%，优于以成分为主的复苏，这表明以白细胞为主的复苏在改善早期死亡率方面可能更有优势。应进行前瞻性随机试验：治疗，III 级。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.