212th Combat Support Hospital, Miseau, Germany.
Transfusion. 2013 Jan;53 Suppl 1:107S-113S. doi: 10.1111/trf.12044.
In Afghanistan, a substantial portion of resuscitative combat surgery is performed by US Army forward surgical teams (FSTs). Red blood cells (RBCs) and fresh frozen plasma (FFP) are available at these facilities, but platelets are not. FST personnel frequently encounter high-acuity patient scenarios without the ability to transfuse platelets. An analysis of the use of fresh whole blood (FWB) at FSTs therefore allows for an evaluation of outcomes associated with this practice.
A retrospective analysis was performed in prospectively collected data from all transfused patients at six FSTs from December 2005 to December 2010. Univariate analysis was performed, followed by two separate propensity score analyses. In-hospital mortality was predicted with the use of a conditional logistic regression model that incorporated these propensity scores. Subset analysis included evaluation of patients who received uncrossmatched Type O FWB compared with those who received type-specific FWB.
A total of 488 patients received a blood transfusion. There were no significant differences in age, sex, or Glasgow Coma Scale in those who received or did not receive FWB. Injury Severity Scores were higher in patients transfused FWB. In our adjusted analyses, patients who received RBCs and FFP with FWB had improved survival compared with those who received RBCs and FFP without FWB. Of 94 FWB recipients, 46 FWB recipients (49%) were given uncrossmatched Type O FWB, while 48 recipients (51%) received type-specific FWB. There was no significant difference in mortality between patients that received uncrossmatched Type O and type-specific FWB.
The use of FWB in austere combat environments appears to be safe and is independently associated with improved survival to discharge when compared with resuscitation with RBCs and FFP alone. Mortality was similar for patients transfused uncrossmatched Type O compared with ABO type-specific FWB in an austere setting.
在阿富汗，大量的复苏性战伤外科手术是由美国陆军前方外科医疗队（FST）完成的。这些设施可提供红细胞（RBC）和新鲜冷冻血浆（FFP），但不提供血小板。FST 人员在没有输注血小板能力的情况下经常遇到高急症患者情况。因此，对 FST 使用新鲜全血（FWB）进行分析，可以评估与该实践相关的结果。
对 2005 年 12 月至 2010 年 12 月期间六个 FST 中所有接受输血的患者的前瞻性收集数据进行回顾性分析。进行了单变量分析，然后进行了两个单独的倾向评分分析。使用包含这些倾向评分的条件逻辑回归模型预测住院死亡率。亚组分析包括评估接受未交叉配型 O 型 FWB 的患者与接受特定血型 FWB 的患者。
共有 488 名患者接受了输血。在接受或未接受 FWB 的患者中，年龄、性别或格拉斯哥昏迷评分均无显著差异。输注 FWB 的患者损伤严重程度评分更高。在我们的调整分析中，接受 RBC 和 FFP 与 FWB 的患者的存活率高于仅接受 RBC 和 FFP 而未接受 FWB 的患者。在 94 名 FWB 接受者中，46 名 FWB 接受者（49%）接受了未交叉配型的 O 型 FWB，而 48 名接受者（51%）接受了特定血型的 FWB。在一个艰苦的环境中，接受未交叉配型的 O 型和特定血型 FWB 的患者之间的死亡率没有显著差异。
在艰苦的战斗环境中使用 FWB 似乎是安全的，与单独使用 RBC 和 FFP 复苏相比，独立地与出院时的生存率提高相关。在艰苦的环境中，接受未交叉配型的 O 型与 ABO 特定血型 FWB 输血的患者死亡率相似。
