Association Between Whole Blood Transfusion and Mortality Among Patients With Hemorrhagic Shock and Traumatic Brain Injury

BACKGROUND AND OBJECTIVES: Whole blood (WB) transfusion in trauma has been revisited, and recent studies have reported an association between WB and improved survival among patients with hemorrhagic shock. However, no evidence of a similar association exists for patients with hemorrhagic shock and traumatic brain injury (TBI). This study aimed to assess the association between WB and mortality among patients with hemorrhagic shock and TBI. METHODS: This study retrospectively analyzed data obtained from American College of Surgeons-Trauma Quality Improvement Program during January 2020 to December 2021. Patients (age ≥18 years) requiring blood transfusion within 4 hours of hospital arrival and sustaining TBI (head Abbreviated Injury Scale >2) were included. Survival at 30 days were compared after performing 1:1 propensity score matching for demographics, injury type, vital signs on admission, TBI characteristics, injury characteristics, comorbidities, hemorrhage control procedures, hospital characteristics, and withdrawal of life support. RESULTS: A total of 15 967 patients were eligible for analysis. The median age was 42 years (interquartile range: 28-60 years); 11 789 (73.8%) patients were male, and 10 102 (63.2%) patients were White. Of them, 2725 (17.0%) received WB. After a 1:1 propensity score matching, 2720 matched pairs were compared. Matched patients had 1.0 as median shock index and 79 mm Hg as the lowest systolic blood pressure requiring immediate transfusion. WB was not associated with reduced 30-day mortality, compared with non-WB (34.0% vs 34.7%, odds ratio: 0.97, 95% confidence interval: 0.87-1.09). CONCLUSION: WB was not associated with reduced 30-day mortality among patients with hemorrhagic shock and TBI. These findings suggest that not all patients with hemorrhagic shock would benefit from WB.