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Citation
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Sperry JL, Cotton BA, Luther JF, Cannon JW, Schreiber MA, Moore EE, Namias N, Minei JP, Wisniewski SR, Guyette FX. J. Am. Coll. Surg. 2023; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: Low titer group O whole blood (LTOWB) resuscitation is becoming common in both military and civilian settings and may represent the ideal resuscitation intervention. We sought to characterize the safety and efficacy of LTOWB resuscitation relative to blood component resuscitation.
METHODS: A prospective, multicenter, observational cohort study was performed using seven trauma centers. Injured patients at risk of massive transfusion who required both blood transfusion and hemorrhage control procedures were enrolled. The primary outcome was 4-hour mortality. Secondary outcomes included 24-hour and 28-day mortality, achievement of hemostasis, death from exsanguination and the incidence of unexpected survivors.
RESULTS: 1,051 patients in hemorrhagic shock met all enrollment criteria. The cohort was severely injured with over 70% of patients requiring massive transfusion. After propensity adjustment, no significant 4-hour mortality difference across LTOWB and component patients was found, (RR 0.90, 95%CI 0.59-1.39, p=0.64). Similarly, no adjusted mortality differences were demonstrated at 24-hours or 28 days for the enrolled cohort. When patients with an elevated prehospital probability of mortality were analyzed, LTOWB resuscitation was independently associated with a 48% lower risk of 4-hour mortality (RR 0.52, 95%CI 0.32-0.87, p=0.01) and a 30% lower risk of 28-day mortality (RR 0.70, 95%CI 0.51-0.96, p=0.03).
CONCLUSION: Early LTOWB resuscitation is safe but not independently associated with survival for the overall enrolled population. When patients were selected with an elevated probability of mortality based upon prehospital injury characteristics, LTOWB was independently associated with a lower risk of mortality starting at 4 hours post arrival thru 28 days post-injury.
Language: en |