Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul:61 Suppl 1:S15-S21.
doi: 10.1111/trf.16528.

Prehospital whole blood reduces early mortality in patients with hemorrhagic shock

Maxwell A Braverman  1 , Alison Smith  1 , Douglas Pokorny  1 , Benjamin Axtman  1 , Charles Patrick Shahan  1 , Lauran Barry  1 , Hannah Corral  1 , Rachelle Babbitt Jonas  1 , Michael Shiels  2 , Randall Schaefer  3 , Eric Epley  3 , Christopher Winckler  4 , Elizabeth Waltman  5 , Brian J Eastridge  1 , Susannah E Nicholson  1 , Ronald M Stewart  1 , Donald H Jenkins  1
Affiliations

Prehospital whole blood reduces early mortality in patients with hemorrhagic shock

Maxwell A Braverman et al. Transfusion. 2021 Jul.

Abstract

Background: Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion.

Study design and methods: A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6-h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed.

Results: A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (-0.28 vs. -0.002, p < .001). In a propensity-matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found (p > .05).

Discussion: This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi-institutional prospective studies are needed.

Keywords: mortality; pre-hospital transfusion; propensity match; whole blood.

PubMed Disclaimer

References

REFERENCES

    1. Spinella PC, Cap AP. Prehospital hemostatic resuscitation to achieve zero preventable deaths after traumatic injury. Curr Opin Hematol. 2017;24:529-35.
    1. Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002;52:420-5. https://doi.org/10.1097/00005373-200203000-00002
    1. Berns KS, Zietlow SP. Blood usage in rotor-wing transport. Air Med J. 1998;17:105-8.
    1. Sumida MP, Quinn K, Lewis PL, Jones Y, Baker DE, Ciraulo DL, et al. Prehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients. Air Med J. 2000;19:140-3.
    1. Zielinski MD, Stubbs JR, Berns KS, Glassberg E, Murdock AD, Shinar E, et al. Prehospital blood transfusion programs. J Trauma Acute Care Surg. 2017;82:S70-8.