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Prehospital whole blood reduces early mortality in patients with hemorrhagic shock
Author(s) -
Braverman Maxwell A.,
Smith Alison,
Pokorny Douglas,
Axtman Benjamin,
Shahan Charles Patrick,
Barry Lauran,
Corral Hannah,
Jonas Rachelle Babbitt,
Shiels Michael,
Schaefer Randall,
Epley Eric,
Winckler Christopher,
Waltman Elizabeth,
Eastridge Brian J.,
Nicholson Susannah E.,
Stewart Ronald M.,
Jenkins Donald H.
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16528
Subject(s) - medicine , resuscitation , shock (circulatory) , emergency medicine , propensity score matching , blood transfusion , injury severity score , incidence (geometry) , emergency medical services , packed red blood cells , demographics , blood product , emergency department , surgery , poison control , injury prevention , physics , demography , psychiatry , sociology , optics
Background Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion. Study design and methods A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6‐h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed. Results A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (−0.28 vs. −0.002, p < .001). In a propensity‐matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found ( p > .05). Discussion This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi‐institutional prospective studies are needed.