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Meta-Analysis
. 2024 Jul 1;52(7):e390-e404.
doi: 10.1097/CCM.0000000000006244. Epub 2024 Mar 14.

The Efficacy of Low-Titer Group O Whole Blood Compared With Component Therapy in Civilian Trauma Patients: A Meta-Analysis

Katrina M Morgan  1 , Elissa Abou Khalil  2 , Erin V Feeney  1 , Philip C Spinella  1 , Amelia C Lucisano  1 , Barbara A Gaines  3 , Christine M Leeper  1
Affiliations
Meta-Analysis

The Efficacy of Low-Titer Group O Whole Blood Compared With Component Therapy in Civilian Trauma Patients: A Meta-Analysis

Katrina M Morgan et al. Crit Care Med. .

Abstract

Objectives: To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients.

Data sources: A systematic search of PubMed, CINAHL, and Web of Science was performed from their inception through December 1, 2023. Key terms included injury, hemorrhage, bleeding, blood transfusion, and whole blood.

Study selection: All studies comparing outcomes in injured civilian adults and children who received LTOWB versus CT were included.

Data extraction: Data including author, publication year, sample size, total blood volumes, and clinical outcomes were extracted from each article and reported following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Main outcomes were 24-hour (early) and combined 28-day, 30-day, and in-hospital (late) mortality rates between recipients of LTOWB versus CT, which were pooled using random-effects models.

Data synthesis: Of 1297 studies reviewed, 24 were appropriate for analysis. Total subjects numbered 58,717 of whom 5,164 received LTOWB. Eleven studies included adults-only, seven included both adults and adolescents, and six only included children. The median (interquartile range) age for patients who received LTOWB and CT was 35 years (24-39) and 35.5 years (23-39), respectively. Overall, 14 studies reported early mortality and 22 studies reported late mortality. LTOWB was associated with improved 24-hour survival (risk ratios [RRs] [95% CI] = 1.07 [1.03-1.12]) and late (RR [95% CI] = 1.05 [1.01-1.09]) survival compared with component therapy. There was no evidence of small study bias and all studies were graded as a moderate level of bias.

Conclusions: These data suggest hemostatic resuscitation with LTOWB compared with CT improves early and late survival outcomes in bleeding civilian trauma patients. The majority of subjects were injured adults; multicenter randomized controlled studies in injured adults and children are underway to confirm these findings.

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Conflict of interest statement

Dr. Spinella is a consultant for Cerus and Hemanext, on the advisory board for Haima and Octapharma, and is a Co-Founder and Chief Medical Officer of Kalocyte. He also has funding from Biomedical Advanced Research and Development Authority to perform a trial examining the safety and efficacy of whole blood. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Cannon JW, Johnson MA, Caskey RC, et al.: High ratio plasma resuscitation does not improve survival in pediatric trauma patients. J Trauma Acute Care Surg. 2017; 83:211–217
    1. Holcomb JB, Jenkins D, Rhee P, et al.: Damage control resuscitation: Directly addressing the early coagulopathy of trauma. J Trauma. 2007; 62:307–310
    1. Leibner E, Andreae M, Galvagno SM, et al.: Damage control resuscitation. Clin Exp Emerg Med. 2020; 7:5–13
    1. Butler EK, Mills BM, Arbabi S, et al.: Association of blood component ratios with 24-hour mortality in injured children receiving massive transfusion. Crit Care Med. 2019; 47:975–983
    1. Cunningham RM, Walton MA, Carter PM: The major causes of death in children and adolescents in the United States. N Engl J Med. 2018; 379:2468–2475

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