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The impact of prehospital whole blood on hemorrhaging trauma patients: A multi-center retrospective study

医学 创伤中心 血液制品 堆积红细胞 损伤严重程度评分 急诊医学 输血 复苏 新鲜冰冻血浆 人口统计学的 单变量分析 休克(循环) 血流动力学 麻醉 回顾性队列研究 急诊科 内科学 外科 血小板 毒物控制 伤害预防 多元分析 人口学 社会学 精神科
作者
M.A. Braverman,Steven G Schauer,Angelo Ciaraglia,Erika Brigmon,Alison Smith,Lauran Barry,James A. Bynum,Donna T. Andrew,Hannah Corral,Andrew D Fisher,Eric Epley,Rachelle B. Jonas,Michael Shiels,Elizabeth Waltman,C Winckler,Brian J. Eastridge,Ronald M. Stewart,Susannah E. Nicholson,Donald H. Jenkins
出处
期刊:The journal of trauma and acute care surgery [Lippincott Williams & Wilkins]
卷期号:95 (2): 191-196 被引量:5
标识
DOI:10.1097/ta.0000000000003908
摘要

BACKGROUND Whole blood (WB) use has become increasingly common in trauma centers across the United States for both in-hospital and prehospital resuscitation. We hypothesize that prehospital WB (pWB) use in trauma patients with suspected hemorrhage will result in improved hemodynamic status and reduced in-hospital blood product requirements. METHODS The institutional trauma registries of two academic level I trauma centers were queried for all patients from 2015–2019 who underwent transfusion upon arrival to the trauma bay. Patients who were dead on arrival or had isolated head injuries were excluded. Demographics, injury and shock characteristics, transfusion requirements, including massive transfusion protocol (MTP) (>10 U in 24 hours) and rapid transfusion (CAT3+) and outcomes were compared between pWB and non-pWB patients. Significantly different demographic, injury characteristics and pWB were included in univariate followed by stepwise logistic regression analysis to determine the relationship with shock index (SI). Our primary objective was to determine the relationship between pWB and improved hemodynamics or reduction in blood product utilization. RESULTS A total of 171 pWB and 1391 non-pWB patients met inclusion criteria. Prehospital WB patients had a lower median Injury Severity Score (17 vs. 21, p < 0.001) but higher prehospital SI showing greater physiologic disarray. Prehospital WB was associated with improvement in SI (−0.04 vs. 0.05, p = 0.002). Mortality and (LOS) were similar. Prehospital WB patients received fewer packed red blood cells, fresh frozen plasma, and platelets units across their LOS but total units and volumes were similar. Prehospital WB patients had fewer MTPs (22.6% vs. 32.4%, p = 0.01) despite a similar requirement of CAT3+ transfusion upon arrival. CONCLUSION Prehospital WB administration is associated with a greater improvement in SI and a reduction in MTP. This study is limited by its lack of power to detect a mortality difference. Prospective randomized controlled trials will be required to determine the true impact of pWB on trauma patients. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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