A Pilot Study of Stored Low Titer Group O Whole Blood + Component Therapy versus Component Therapy Only for Civilian Trauma Patients.

Siletz, Anaar E; Blair, Kevin J; Cooper, Richelle J; Nguyen, N Charity; Lewis, Scott J; Fang, Amy; Ward, Dawn C; Jackson, Nicholas J; Rodriguez, Tyler; Grotts, Jonathan; Hwang, Jonathan; Ziman, Alyssa; Cryer, H Gill

BACKGROUND This pilot assessed transfusion requirements during resuscitation with whole blood followed by standard component therapy versus component therapy alone, during a change in practice at a large urban level I trauma center. METHODS This was a single-center prospective cohort pilot study. Male trauma patients received up to 4 units of cold-stored low anti-A, anti-B group O whole blood (LTOWB) as initial resuscitation followed by CT as needed (LTOWB + CT). A control group consisting of females, and males who presented when LTOWB was unavailable, received component therapy only (CT group). Exclusion criteria included antiplatelet or anticoagulant medication and death within 24 hours. The primary outcome was total transfusion volume at 24 hours. Secondary outcomes were mortality, morbidity, and ICU- and hospital-free days. RESULTS Thirty-eight patients received LTOWB, with a median of 2.0 [IQR 1.0, 3.0] units of LTOWB transfused. Thirty-two patients received CT only. At 24 hours after presentation, the LTOWB +CT group had received a median of 2138 mL [IQR 1275-3325] of all blood products. The median for the CT group was 4225 mL [IQR 1900-5425], p = 0.06 in unadjusted analysis. When adjusted for Injury Severity Score, sex, and positive Focused Assessment with Sonography for Trauma (FAST), LTOWB +CT group patients received 3307 mL of blood products and CT group patients received 3260 mL in the first 24 hours (p = 0.95). The adjusted median ratio of plasma to red cells transfused was higher in the LTOWB + CT group (0.85 vs 0.63 at 24 hours after admission, p = 0.043. Adjusted mortality was 4.4% in the LTOWB + CT group, and 11.7% in the CT group (p = 0.19), with similar complications, ICU-, and hospital-free days in both groups. CONCLUSIONS Beginning resuscitation with LTOWB results in equivalent outcomes compared to resuscitation with CT only. LEVEL OF EVIDENCE Therapeutic, Level III (Prospective study with 1 negative criterion, limited control of confounding factors).