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Comparative Study
. 2009 Apr;66(4 Suppl):S69-76.
doi: 10.1097/TA.0b013e31819d85fb.

Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries

Philip C Spinella  1 , Jeremy G Perkins, Kurt W Grathwohl, Alec C Beekley, John B Holcomb
Affiliations
Comparative Study

Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries

Philip C Spinella et al. J Trauma. 2009 Apr.

Abstract

Background: Increased understanding of the pathophysiology of the acute coagulopathy of trauma has lead many to question the current transfusion approach to hemorrhagic shock. We hypothesized that warm fresh whole blood (WFWB) transfusion would be associated with improved survival in patients with trauma compared with those transfused only stored component therapy (CT).

Methods: We retrospectively studied US Military combat casualty patients transfused >or=1 unit of red blood cells (RBCs). The following two groups of patients were compared: (1) WFWB, who were transfused WFWB, RBCs, and plasma but not apheresis platelets and (2) CT, who were transfused RBC, plasma, and apheresis platelets but not WFWB. The primary outcomes were 24-hour and 30-day survival.

Results: Of 354 patients analyzed there were 100 in the WFWB and 254 in the CT group. Patients in both groups had similar severity of injury determined by admission eye, verbal, and motor Glasgow Coma Score, base deficit, international normalized ratio, hemoglobin, systolic blood pressure, and injury severity score. Both 24-hour and 30-day survival were higher in the WFWB cohort compared with CT patients, 96 of 100 (96%) versus 223 of 254 (88%), (p = 0.018) and 95% to 82%, (p = 0.002), respectively. An increased amount (825 mL) of additives and anticoagulants were administered to the CT compared with the WFWB group, (p < 0.001). Upon multivariate logistic regression the use of WFWB and the volume of WFWB transfused was independently associated with improved 30-day survival.

Conclusions: In patients with trauma with hemorrhagic shock, resuscitation strategies that include WFWB may improve 30-day survival, and may be a result of less anticoagulants and additives with WFWB use in this population.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier curve of 30-day survival according to study group.
See this image and copyright information in PMC

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References

    1. CDC Deaths: final data for 2004. 2007 Available at: http://www.cdc.gov/nchs/deaths.htm. - PubMed
    1. AAST [Accessed February 20, 2009];Trauma Facts. 2008 Available at: http://www.aast.org/TraumaFacts/dynamic.aspx?id=964.
    1. Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55–62. - PubMed
    1. Holcomb JB, Caruso J, McMullin NR, et al. Causes of death in special operations forces on the modern battlefield: 2001–2004. Ann Surg. 2007;245:986–991. - PMC - PubMed
    1. Esposito TJ, Sanddal ND, Hansen JD, Reynolds S. Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma. 1995;39:955–962. - PubMed