育龄女性全血创伤复苏的演变:实践模式和趋势。

IF 2.1 Q3 CRITICAL CARE MEDICINE Trauma Surgery & Acute Care Open Pub Date : 2024-12-07 eCollection Date: 2024-01-01 DOI:10.1136/tsaco-2024-001587
Alexandra Mp Brito, Mark H Yazer, Jason L Sperry, James F Luther, Stephen R Wisniewski, Frances Guyette, Ernest E Moore, Bryan A Cotton, Laura Vincent, Erin Fox, Jeremy W Cannon, Nicholas Namias, Joseph P Minei, Lee Anne Ammons, Skye Clayton, Martin Schreiber
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引用次数: 0

摘要

背景:低效价O型全血(LTOWB)用于外伤性出血患者的复苏越来越普遍。由于对RhD同种异体免疫的关注,各机构对育龄女性(CBAFs)给予RhD阳性LTOWB的做法各不相同。本研究检查了与LTOWB输血有关的实践,因为它们与年龄和性别有关。方法:这是对休克、全血和TBI(创伤性脑损伤)评估试验的二次分析,这是一项前瞻性、多中心观察性队列研究,分析了2018年至2021年7个一级创伤中心LTOWB输血后的结果,以及2023年对这些中心输血实践的调查。在研究过程中,研究人员检查了接受LTOWB或成分治疗的患者比例,并按年龄和性别分组,并记录了CBAFs损伤的RhD组。结果:共评估了1046例患者,其中女性130例,年龄大。结论:许多机构向CBAFs输注LTOWB。关于RhD产品选择的政策各不相同。在整个队列中,rhd阴性cafs接受LTOWB的比例随着时间的推移而增加,但仍低于所有其他组。证据等级:3。
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Evolution of whole blood trauma resuscitation in childbearing age females: practice patterns and trends.

Background: The use of low titer group O whole blood (LTOWB) for resuscitation of patients with traumatic hemorrhage is becoming increasingly common. Practices regarding the administration of RhD-positive LTOWB to childbearing age females (CBAFs) vary between institutions due to concerns about RhD alloimmunization. This study examined practices related to LTOWB transfusion as they pertain to age and sex.

Methods: This was a secondary analysis of the Shock, Whole blood, and Assessment of TBI (traumatic brain injury) trial, a prospective, multicenter observational cohort study where outcomes following LTOWB transfusion were analyzed at seven level 1 trauma centers between 2018 and 2021, as well as a survey on transfusion practices at these centers conducted in 2023. The proportion of patients who received LTOWB or components was examined over the course of the study and grouped by age and sex, and the RhD group of injured CBAFs was documented.

Results: A total of 1046 patients were evaluated: 130 females aged <50 years (CBAFs), 77 females aged ≥50 years; 661 males aged <50 years, and 178 males aged ≥50 years. Among them, 26.2% of CBAFs received RhD-positive LTOWB, whereas 57.1%-66.3% of other sex/age groups received LTOWB. The proportion of CBAFs who received LTOWB increased significantly throughout the 4 years of this study. Except for older women in years 2 and 4, CBAFs were significantly less likely to receive LTOWB than all other groups for the study period and individual years. Among the 33 CBAFs who received LTOWB and for whom an RhD type was available, 4/33 (12.1%) were RhD-negative, while 9/95 (9.5%) CBAFs who received component therapy were RhD-negative. RhD blood product selection practices varied considerably between institutions.

Conclusions: Many institutions transfused LTOWB to CBAFs. Policies regarding RhD product selection varied. Of the total cohort, the proportion of RhD-negative CBAFs who received LTOWB increased over time but remained lower than all other groups.

Level of evidence: 3.

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来源期刊
CiteScore
3.70
自引率
5.00%
发文量
71
审稿时长
12 weeks
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