Joshua Paul Hazelton1, Jeremy W Cannon, Catherine Zatorski, Janika San Roman, Sarah A Moore, Andrew J Young, Madhu Subramanian, Jessica F Guzman, Franz Fogt, Anna Moran, John Gaughan, Mark J Seamon, John Porter. 1. From the Division of Trauma, Acute Care & Critical Care Surgery (J.P.H.), Penn State College of Medicine, Hershey; Division of Traumatology, Surgical Critical Care & Emergency Surgery (J.W.C.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery (J.W.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery (C.Z.), Lehigh Valley Health Network, Allentown, Pennsylvania; Division of Trauma, Surgical Critical Care & Acute Care Surgery (J.S.R.), Cooper University Hospital, Camden, New Jersey; Department of Surgery (S.A.M.), University of New Mexico, Albuquerque, New Mexico; Division of Traumatology, Surgical Critical Care & Emergency Surgery (A.J.Y.), Division of Traumatology, Surgical Critical Care & Emergency Surgery (M.S.), Perelman School of Medicine at the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania (J.F.G.), Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine (F.F., A.M.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine (J.F.G.), Cooper University Hospital, Camden, New Jersey; Division of Traumatology, Surgical Critical Care and Emergency Surgery (M.J.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Trauma, Surgical Critical Care and Acute Care Surgery (J.P.), Cooper University Hospital, Camden, New Jersey.
Abstract
BACKGROUND: Cold-stored whole blood (CWB) provides a balance of red blood cells, plasma, and platelets in less anticoagulant volume than standard blood component therapy (BCT). We hypothesize that patients receiving CWB along with BCT have improved survival compared with patients receiving only BCT. METHODS: We performed a dual-center case-match study of trauma patients who received CWB and BCT at two urban, Level-I Trauma Centers. Criteria to receive CWB included boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 0.05 was significant. RESULTS: Between both institutions, a total of 107 patients received CWB during the study period with 91 being matched to 182 BCT patients for analysis. Hemodynamic parameters of the patients in both groups at the time of presentation were similar. The CWB patients had higher mean hemoglobin (10 ± 2 g/dL vs. 11 ± 2 g/dL; p < 0.001) and hematocrit (29.2 ± 6.1% vs. 32.1 ± 5.8%; p < 0.001) at 24 hours. Importantly, trauma bay mortality was less in CWB patients (8.8% vs. 2.2%;p = 0.039). Thirty-day mortality was not different in CWB patients, and there were no differences in the total amount of blood products transfused at the 4-hour and 24-hour periods. CONCLUSION: Cold-stored whole blood offers the benefit of a balanced resuscitation with improved trauma bay survival and higher mean hemoglobin at 24 hours. A larger, prospective study is needed to determine whether it has a longer-term survival benefit for severely injured patients. LEVEL OF EVIDENCE: Therapeutic, level III.
BACKGROUND: Cold-stored whole blood (CWB) provides a balance of red blood cells, plasma, and platelets in less anticoagulant volume than standard blood component therapy (BCT). We hypothesize that patients receiving CWB along with BCT have improved survival compared with patients receiving only BCT. METHODS: We performed a dual-center case-match study of traumapatients who received CWB and BCT at two urban, Level-I Trauma Centers. Criteria to receive CWB included boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any traumapatient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 0.05 was significant. RESULTS: Between both institutions, a total of 107 patients received CWB during the study period with 91 being matched to 182 BCT patients for analysis. Hemodynamic parameters of the patients in both groups at the time of presentation were similar. The CWBpatients had higher mean hemoglobin (10 ± 2 g/dL vs. 11 ± 2 g/dL; p < 0.001) and hematocrit (29.2 ± 6.1% vs. 32.1 ± 5.8%; p < 0.001) at 24 hours. Importantly, trauma bay mortality was less in CWBpatients (8.8% vs. 2.2%;p = 0.039). Thirty-day mortality was not different in CWBpatients, and there were no differences in the total amount of blood products transfused at the 4-hour and 24-hour periods. CONCLUSION: Cold-stored whole blood offers the benefit of a balanced resuscitation with improved trauma bay survival and higher mean hemoglobin at 24 hours. A larger, prospective study is needed to determine whether it has a longer-term survival benefit for severely injured patients. LEVEL OF EVIDENCE: Therapeutic, level III.
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