• Joshua P Hazelton, Anna E Ssentongo, John S Oh, Paddy Ssentongo, Mark J Seamon, James P Byrne, Isabella G Armento, Donald H Jenkins, Maxwell A Braverman, Caleb Mentzer, Guy C Leonard, Lindsey L Perea, Courtney K Docherty, Julie A Dunn, Brittany Smoot, Matthew J Martin, Jayraan Badiee, Alejandro J Luis, Julie L Murray, Matthew R Noorbakhsh, James E Babowice, Charles Mains, Robert M Madayag, KaafaraniHaytham M AHMAMassachusetts General Hospital, Boston, MA., Ava K Mokhtari, Sarah A Moore, Kathleen Madden, Allen Tanner, Diane Redmond, David J Millia, Amber Brandolino, Uyen Nguyen, Vernon Chinchilli, Scott B Armen, and John M Porter.
• Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
• Ann. Surg. 2022 Oct 1; 276 (4): 579-588.

ObjectiveThe aim of this study was to identify a mortality benefit with the use of whole blood (WB) as part of the resuscitation of bleeding trauma patients.BackgroundBlood component therapy (BCT) is the current standard for resuscitating trauma patients, with WB emerging as the blood product of choice. We hypothesized that the use of WB versus BCT alone would result in decreased mortality.MethodsWe performed a 14-center, prospective observational study of trauma patients who received WB versus BCT during their resuscitation. We applied a generalized linear mixed-effects model with a random effect and controlled for age, sex, mechanism of injury (MOI), and injury severity score. All patients who received blood as part of their initial resuscitation were included. Primary outcome was mortality and secondary outcomes included acute kidney injury, deep vein thrombosis/pulmonary embolism, pulmonary complications, and bleeding complications.ResultsA total of 1623 [WB: 1180 (74%), BCT: 443(27%)] patients who sustained penetrating (53%) or blunt (47%) injury were included. Patients who received WB had a higher shock index (0.98 vs 0.83), more comorbidities, and more blunt MOI (all P <0.05). After controlling for center, age, sex, MOI, and injury severity score, we found no differences in the rates of acute kidney injury, deep vein thrombosis/pulmonary embolism or pulmonary complications. WB patients were 9% less likely to experience bleeding complications and were 48% less likely to die than BCT patients ( P <0.0001).ConclusionsCompared with BCT, the use of WB was associated with a 48% reduction in mortality in trauma patients. Our study supports the use of WB use in the resuscitation of trauma patients.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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