Quantifying the benefit of whole blood on mortality in trauma patients requiring emergent laparotomy

被引:1
作者
Lammers, Daniel [1 ]
Betzold, Richard [1 ]
McClellan, John [2 ]
Eckert, Matthew [2 ]
Bingham, Jason [3 ]
Hu, Parker [4 ]
Hurst, Stuart [1 ]
Baird, Emily [1 ]
Hashmi, Zain [1 ]
Kerby, Jeffrey [1 ]
Jansen, Jan O. [1 ]
Holcomb, John B. [1 ]
机构
[1] Univ Alabama Birmingham, Heersink Sch Med, Ctr Injury Sci, Birmingham, AL USA
[2] Univ N Carolina, Div Acute Care & Trauma Surg, Chapel Hill, NC USA
[3] Madigan Army Med Ctr, Dept Gen Surg, Tacoma, WA USA
[4] Chippenham Hosp, Dept Trauma & Acute Care Surg, Richmond, VA USA
关键词
Bayesian; blood components; hemorrhagic shock; resuscitation; whole blood; RESUSCITATION; HEMORRHAGE; SURVIVAL;
D O I
10.1097/TA.0000000000004382
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND Whole blood (WB) transfusions in trauma represent an increasingly utilized resuscitation strategy in trauma patients. Previous reports suggest a probable mortality benefit with incorporating WB into massive transfusion protocols. However, questions surrounding optimal WB practices persist. We sought to assess the association between the proportion of WB transfused during the initial resuscitative period and its impact on early mortality outcomes for traumatically injured patients. METHODS We performed a retrospective analysis of severely injured patients requiring emergent laparotomy and >= 3 units of red blood cell containing products (WB or packed red blood cells) within the first hour from an ACS Level I Trauma Center (2019-2022). Patients were evaluated based on the proportion of WB they received compared with packed red blood cells during their initial resuscitation (high ratio cohort >= 50% WB vs. low ratio cohort <50% WB). Multilevel Bayesian regression analyses were performed to calculate the posterior probabilities and risk ratios (RR) associated with a WB predominant resuscitation for early mortality outcomes. RESULTS Two hundred sixty-six patients were analyzed (81% male; mean age, 36 years; 61% penetrating injury; mean Injury Severity Score, 30). The mortality was 11% at 4 hours and 14% at 24 hours. The high ratio cohort demonstrated a 99% (RR, 0.12; 95% credible interval, 0.02-0.53) and 99% (RR, 0.22; 95% credible interval, 0.08-0.65) probability of decreased mortality at 4 hours and 24 hours, respectively, compared the low ratio cohort. There was a 94% and 88% probability of at least a 50% mortality relative risk reduction associated with the WB predominate strategy at 4 hours and 24 hours, respectively. CONCLUSION Preferential transfusion of WB during the initial resuscitation demonstrated a 99% probability of being superior to component predominant resuscitations with regards to 4-hour and 24-hour mortality suggesting that WB predominant resuscitations may be superior for improving early mortality. Prospective, randomized trials should be sought.
引用
收藏
页码:747 / 752
页数:6
相关论文
共 27 条
[1]   The Evolution of Blood Transfusion in the Trauma Patient: Whole Blood Has Come Full Circle [J].
Black, Jonathan A. ;
Pierce, Virginia S. ;
Kerby, Jeffrey D. ;
Holcomb, John B. .
SEMINARS IN THROMBOSIS AND HEMOSTASIS, 2020, 46 (02) :215-220
[2]  
Bolstad W. M., 2016, Introduction to Bayesian Statistics
[3]   Impact of Incorporating Whole Blood into Hemorrhagic Shock Resuscitation: Analysis of 1,377 Consecutive Trauma Patients Receiving Emergency-Release Uncrossmatched Blood Products [J].
Brill, Jason B. ;
Tang, Brian ;
Hatton, Gabrielle ;
Mueck, Krislynn M. ;
McCoy, C. Cameron ;
Kao, Lillian S. ;
Cotton, Bryan A. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2022, 234 (04) :408-418
[4]   brms: An R Package for Bayesian Multilevel Models Using Stan [J].
Buerkner, Paul-Christian .
JOURNAL OF STATISTICAL SOFTWARE, 2017, 80 (01) :1-28
[5]   The use of whole blood in traumatic bleeding: a systematic review [J].
Cruciani, Mario ;
Franchini, Massimo ;
Mengoli, Carlo ;
Marano, Giuseppe ;
Pati, Ilaria ;
Masiello, Francesca ;
Veropalumbo, Eva ;
Pupella, Simonetta ;
Vaglio, Stefania ;
Agostini, Vanessa ;
Liumbruno, Giancarlo Maria .
INTERNAL AND EMERGENCY MEDICINE, 2021, 16 (01) :209-220
[6]   EARLIER ENDPOINTS ARE REQUIRED FOR HEMORRHAGIC SHOCK TRIALS AMONG SEVERELY INJURED PATIENTS [J].
Fox, Erin E. ;
Holcomb, John B. ;
Wade, Charles E. ;
Bulger, Eileen M. ;
Tilley, Barbara C. .
SHOCK, 2017, 47 (05) :567-573
[7]   Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial [J].
Goligher, Ewan C. ;
Tomlinson, George ;
Hajage, David ;
Wijeysundera, Duminda N. ;
Fan, Eddy ;
Juni, Peter ;
Brodie, Daniel ;
Slutsky, Arthur S. ;
Combes, Alain .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2018, 320 (21) :2251-2259
[8]   Improved survival in critically injured combat casualties treated with fresh whole blood by forward surgical teams in Afghanistan [J].
Gurney, Jennifer ;
Staudt, Amanda ;
Cap, Andrew ;
Shackelford, Stacy ;
Mann-Salinas, Elizabeth ;
Le, Tuan ;
Nessen, Shawn ;
Spinella, Philip .
TRANSFUSION, 2020, 60 :S180-S188
[9]   Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties [J].
Gurney, Jennifer M. ;
Staudt, Amanda M. ;
Del Junco, Deborah J. ;
Shackelford, Stacy A. ;
Mann-Salinas, Elizabeth A. ;
Cap, Andrew P. ;
Spinella, Philip C. ;
Martin, Matthew J. .
SURGERY, 2022, 171 (02) :518-525
[10]   Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma [J].
Hanna, Kamil ;
Bible, Letitia ;
Chehab, Mohamad ;
Asmar, Samer ;
Douglas, Molly ;
Ditillo, Michael ;
Castanon, Lourdes ;
Tang, Andrew ;
Joseph, Bellal .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2020, 89 (02) :329-335