Safety and efficacy of low-titer O whole blood resuscitation in a civilian level I trauma center

Phillip M Kemp Bohan; Patrick M McCarthy; Morgan E Wall; Alexandra M Adams; Robert C Chick; Jason E Forcum; Jason S Radowsky; Remealle A How; Valerie G Sams

doi:10.1097/TA.0000000000003289

Safety and efficacy of low-titer O whole blood resuscitation in a civilian level I trauma center

J Trauma Acute Care Surg. 2021 Aug 1;91(2S Suppl 2):S162-S168. doi: 10.1097/TA.0000000000003289.

Authors

Phillip M Kemp Bohan¹, Patrick M McCarthy, Morgan E Wall, Alexandra M Adams, Robert C Chick, Jason E Forcum, Jason S Radowsky, Remealle A How, Valerie G Sams

Affiliation

¹ From the Department of Surgery (P.M.K.B., P.M.M., A.M.A., R.C.C.), Brooke Army Medical Center, Fort Sam Houston, Texas; Uniformed Services University of the Health Sciences (M.E.W.), Bethesda, Maryland; and Department of Trauma and Acute Care Surgery (J.E.F., J.S.R., R.A.H., V.G.S.), Brooke Army Medical Center, Fort Sam Houston, Texas.

PMID: 34039931
DOI: 10.1097/TA.0000000000003289

Abstract

Background: Military experience has shown low-titer O whole blood (LTOWB) to be safe and beneficial in the resuscitation of hemorrhaging trauma patients. However, few civilian centers use LTOWB for trauma resuscitation. We evaluated the early experience and safety of a LTOWB program at a level 1 civilian trauma center.

Methods: We retrospectively reviewed our trauma registry from January 2018 to June 2020 for patients admitted in shock (defined as ≥1 of the following: heart rate, >120 beats per minute; systolic blood pressure, <90 mm Hg; or shock index, >0.9) who received blood products within 24 hours. Patients were grouped by resuscitation provided: LTOWB (group 1), component therapy (CT; group 2), and LTOWB-CT (group 3). Safety, outcomes, and variables associated with LTOWB transfusion and mortality were analyzed.

Results: 216 patients were included: 34 in Group 1, 95 in Group 2, and 87 in Group 3. Patientsreceiving LTOWB were more commonly male (p<0.001) and had a penetrating injury (p=0.005). Groups 1 and 3 had higher median ISS scores compared to Group 2 (19 and 20 vs 17; p=0.01). Group 3 received more median units of blood product in the first 4h (p<0.001) and in the first 24h (p<0.001). There was no difference between groups in 24h mortality or transfusion-related complications (all p>0.05). Arrival ED SBP was associated with LTOWB transfusion (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.95-1.00, p=0.03). ED lactate was independently associated with 24h mortality. (OR 1.27, CI 1.02-1.58, p=0.03). LTOWB transfusion was not associated with mortality (p=0.49). Abstract.

Conclusion: Severely injured patients received LTOWB-CT and more overall product units but had similar 24 h mortality when compared with the LTOWB or CT groups. No increase in transfusion-related complications was seen after LTOWB transfusion. Low-titer O whole blood should be strongly considered in the resuscitation of trauma patients at civilian centers.

Level of evidence: Retrospective, therapeutic, level IV.

MeSH terms

Adult
Exchange Transfusion, Whole Blood* / adverse effects
Exchange Transfusion, Whole Blood* / methods
Female
Humans
Length of Stay
Male
Middle Aged
Registries
Resuscitation / adverse effects
Resuscitation / methods*
Retrospective Studies
Shock, Hemorrhagic / mortality
Shock, Hemorrhagic / therapy*
Trauma Centers*
Treatment Outcome
Wounds and Injuries / mortality
Wounds and Injuries / therapy*
Young Adult