Open AccessWhole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta‐analysis
Author(s) -
Crowe Ellen,
DeSantis Stacia M.,
Bonnette Austin,
Jansen Jan O.,
Yamal JoseMiguel,
Holcomb John B.,
Pedroza Claudia,
Harvin John A.,
Marques Marisa B.,
Avritscher Elenir B.C.,
Wang Henry E.
Publication year - 2020
Publication title -
journal of the american college of emergency physicians open
Language(s) - English
Resource type - Journals
ISSN - 2688-1152
DOI - 10.1002/emp2.12089
Subject(s) - medicine , meta analysis , blood transfusion , systematic review , resuscitation , odds ratio , blood product , whole blood , confidence interval , cochrane library , blood component , emergency medicine , transfusion therapy , intensive care medicine , medline , surgery , political science , law
Background Patients with hemorrhagic shock from trauma often require balanced blood product transfusion with red blood cells, plasma, and platelets. Resuscitation with whole blood resuscitation is becoming a common practice. We performed a systematic review and meta‐analysis of studies comparing whole blood transfusion with balanced component therapy in patients suffering from traumatic hemorrhagic shock. Methods We searched MEDLINE Ovid, EMBASE, and the Cochrane Library for human studies comparing whole blood with component blood therapy published from January 2007 to June 2019. We included studies from both civilian and military settings and that reported 24‐hour, in‐hospital, or 30‐day mortality. We followed the Preferred Reporting Items in Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, assessing study quality, publication bias, and heterogeneity. We used meta‐analytic models to determine the associations (odds ratio [OR] with 95% confidence interval [CI]) between whole blood transfusion and (1) 24‐hour mortality, and (2) in‐hospital or 30‐day mortality. Results A total of 1759 identified studies, 12 (reporting on n = 8431 patients) met inclusion criteria. There was heterogeneity in the design, setting, interventions, and outcomes of the studies. On meta‐analysis, whole blood transfusion was not associated with 24‐hour mortality (OR = 0.83; 95% CI = 0.56–1.24) or in‐hospital/30‐day mortality (OR = 0.79; 95% CI = 0.48–1.31). Conclusion In this systematic review and meta‐analysis, compared with conventional component transfusion, whole blood was not associated with 24‐hour or in‐hospital mortality. However, there were important limitations with and heterogeneity among the primary studies. Additional study is needed to determine the effectiveness of whole blood.