R. Goldsmith1, H. Hosseinpour1, C. Stewart1, O. Hejazi1, C. Colosimo1, Q. Alizai1, T. Anand1, L. Castanon1, L. J. Magnotti1, B. Joseph1 1University Of Arizona, Division Of Trauma, Critical Care, Burns, And Emergency Surgery, Department Of Surgery, Tucson, AZ, USA
Introduction: The use of whole blood (WB) is becoming increasingly popular in the resuscitation of civilian trauma patients requiring massive transfusion (MT). However, it is unclear what volume of WB a center may need to maintain an adequate inventory. The aim of this study was to determine the current WB requirements for massively transfused hemorrhaging civilian trauma patients, using the military concept of whole blood equivalent (WBE), across different levels of trauma centers in the United States.
Methods: This is a retrospective analysis of the ACS-TQIP database over 4 years (2017-2020). Adult (≥16 years) trauma patients who received WB as an adjunct to MT were included. MT was defined as a transfusion of ≥ 4 units of PRBC in 1 hour, ≥5 units in 4 hours, or ≥10 units in 24 hours. The primary outcome was WBE, which was calculated for each patient as units of whole blood plus equivalent component product units (1RBC + 1 FFP + 0.2 Platelet) to identify data on 24-hour transfusion requirements.
Results: A total of 1,261 patients were identified. The mean (SD) age was 41 (18) and 78% were male. The mean initial shock index was 1.1 (0.5), with the mean (SD) lowest SBP of 69 (32) during resuscitation in the emergency department. Presenting median [IQR] GCS and ISS were 7 [3-15] and 25 [17-34], respectively, with 66% suffering from blunt mechanisms of injuries. The overall rates of 6-hr, 24-hr, and in-hospital mortality were 15.5%, 24.9%, and 42.2%, respectively. The median [IQR] 24-hour PRBC, FFP, Platelet, and WB were 12 [8-20], 9 [6-15], 2 [1-4], and 2 [1-3], respectively. The median 24-hr WBE transfusion was 9 units, 75% of patients required 14 units or less, and 95% required 29 units or less. There was no difference in terms of median WBE transfusions for individuals requiring MT across different levels of trauma centers (Level I: 9U, Level II: 9U, Level III and lower: 9U, p=0.333).
Conclusion: On a nationwide scale, among patients who received WB as a part of MT, 75% of patients received a maximum of 14 WBE units during their resuscitation. These findings provide important insights to trauma centers on the volume of WB required to maintain adequate WB inventory to effectively support the successful implementation of future WB programs.