A. A. Smith1, M. Braverman1, B. Axtman1, C. P. Shahan1, D. Pokorny1, L. Barry1, H. Corral1, M. Shiels1, S. Schauer2, J. Bynum2, R. Schaefer3, E. Epley3, C. Winckler1, B. Eastridge1, S. Nicholson1, D. E. Jenkins1 1University Of Texas Health Science Center At San Antonio,Surgery,San Antonio, TX, USA 2US Army Institute of Surgical Research,JBSA Fort Sam Houston,San Antonio, TX, USA 3Southwest Texas Regional Advisory Council,San Antonio, TX, USA
Background: Hemorrhagic shock conveys significant mortality in trauma patients despite increasing advances in pre-hospital care. The benefit of whole blood transfusion in pre-hospital cardiac arrest has not been previously reported. The objective of this study was to determine if patients in cardiac arrest who received pre-hospital low titer O+ whole blood (PH-LTOWB) had improved survival in the trauma bay and also improved overall survival to discharge.
Methods: A retrospective review of 546 trauma patients receiving blood transfusions was performed from 2015-2019. Inclusion criteria included patients with documented prehospital cardiac arrest and patients were excluded if the full prehospital record was not available. Univariate analysis was performed.
Results: 40 (7.3%) patients had on-scene CPR with 11 patients receiving PH-LTOWB. Baseline demographics, ISS, AIS chest and AIS abdomen, and arrival pH were similar between groups (p>0.05). Higher AIS head was found in the non-transfused cohort (2.7+/- 0.3 vs. 3.9+/- 0.2, p=0.003). EMS on scene time was significantly longer in the patients receiving PH-LTOWB (18.4+/- 1.6 vs 11.1+/- 1.4 min, p=0.006). Trauma bay mortality was similar with 63.6% (n=7) in the transfused group and 55.0% in the non-transfused group (n=22) (p=0.46). In-hospital mortality for the PH-LTOWB group was 81.8% and 100% for the non-transfused group (p=0.07).
Conclusions: Pre-hospital blood is an important adjunct in the surgeon's armamentarium for the management of patients with hemorrhagic shock. In our study, we found no survival benefit in transfusing PH-LTOWB for trauma patients in cardiac arrest on the scene and with likely unsurvivable injuries. We also found a longer on-scene time for patients receiving blood transfusions. Blood should be reserved for patients with a survival benefit.
