G. Feinberg1, T. Kheirbek1 1Brown University School Of Medicine, Department Of Surgery, Providence, RI, USA
Introduction: Whole blood (WB) transfusion has shown benefit in reducing mortality in hemorrhaging trauma patients. However, most patients receive additional units of component therapy following initial WB usage. There has been scarce literature regarding the management of subsequent blood components in patients after receiving WB. The purpose of this study is to examine the impact of balanced component therapy in the context of WB resuscitation.
Methods: We analyzed the Trauma Quality Improvement Project (TQIP) databases from years 2020-22 to identify adult patients who underwent hemorrhage control surgery and concurrently received WB and pRBC within 4-hours of arrival. This analysis excluded transfers, burns, severe traumatic brain injuries, emergency department deaths, and prehospital cardiac arrests. Balanced transfusion (BT) was defined as receiving a pRBC:FFP ratio of 0.8-1.2:1 and unbalanced transfusion (UT) was defined as receiving higher ratios. Primary outcomes were 4-hour and 24-hour mortality. Multiple logistic regression were performed controlling for patient comorbidities, injury pattern, and interventions. Variable selection was determined using Lasso regression modeling with cross validation.
Results: Our cohort included 5,489 patients, of which 2,355 received BT (42.9%). There were no significant differences in age or injury mechanism. 24-hour mortality was similar between groups (BT:17.2% vs UT:16.4%, P = 0.43). There was a higher rate of massive transfusion (≥10 units of WB and/or pRBC) in the BT cohort (43.4% vs. 32.3%; P < 0.001). Multiple logistic regression revealed that patients who received WB with BT had significantly lower odds of mortality at 4 hours (adjusted OR: 0.55, 95% CI: 0.45-0.68) and at 24 hours (adjusted OR: 0.73, 95% CI: 0.61-0.89).
Conclusion: In patients receiving WB, maintaining balance of component therapy remains beneficial in hemorrhaging trauma patients.