Emergency Department, North Bristol NHS Trust, Bristol, UK
Trauma Sciences, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK.
Emerg Med J. 2020 Jun;37(6):370-378. doi: 10.1136/emermed-2019-209040. Epub 2020 May 6.
In the era of damage control resuscitation of trauma patients with acute major haemorrhage, transfusion practice has evolved to blood component (component therapy) administered in a ratio that closely approximates whole blood (WB). However, there is a paucity of evidence supporting the optimal transfusion strategy in these patients. The primary objective was therefore to establish if there is an improvement in survival at 30 days with the use of WB transfusion compared with blood component therapy in adult trauma patients with acute major haemorrhage.
A systematic literature search was performed on 15 December 2019 to identify studies comparing WB transfusion with component therapy in adult trauma patients and mortality at 30 days. Studies which did not report mortality were excluded. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development and Evaluation approach.
Search of the databases identified 1885 records, and six studies met the inclusion criteria involving 3255 patients. Of the three studies reporting 30-day mortality (one randomised controlled trial (moderate evidence) and two retrospective (low and very low evidence, respectively)), only one study demonstrated a statistically significant difference between WB and component therapy, and two found no statistical difference. Two retrospective studies reporting in-hospital mortality found no statistical difference in unadjusted mortality, but both reported statistically significant logistic regression analyses demonstrating that those with a WB transfusion strategy were less likely to die.
Recognising the limitations of this systematic review relating to the poor-quality evidence and limited number of included trials, it does not provide evidence to support or reject use of WB transfusion compared with component therapy for adult trauma patients with acute major haemorrhage.
CRD42019131406.
在创伤患者急性大出血的损伤控制性复苏时代，输血实践已经发展到接近全血（WB）比例输注血液成分（成分治疗）。然而，支持这些患者最佳输血策略的证据很少。因此，主要目的是确定与成分治疗相比，在急性大出血的成年创伤患者中使用 WB 输血是否能提高 30 天的生存率。
于 2019 年 12 月 15 日进行了系统文献检索，以确定比较 WB 输血与成年创伤患者成分治疗的研究，并评估 30 天死亡率。未报告死亡率的研究被排除。使用 Cochrane 偏倚风险工具评估纳入研究的方法学质量，并使用推荐评估、制定与评价分级方法进行评级。
数据库搜索共确定了 1885 条记录，有 6 项研究符合纳入标准，涉及 3255 例患者。在报告 30 天死亡率的三项研究中（一项随机对照试验（中等证据）和两项回顾性研究（低和极低证据）），只有一项研究显示 WB 与成分治疗之间存在统计学显著差异，而两项研究则没有统计学差异。两项报告院内死亡率的回顾性研究发现，未调整死亡率无统计学差异，但两者均报告了统计学显著的逻辑回归分析，表明 WB 输血策略的患者死亡可能性较小。
鉴于本系统评价与低质量证据和纳入试验数量有限相关的局限性，本研究并未提供支持或反对与成分治疗相比，在急性大出血的成年创伤患者中使用 WB 输血的证据。
PROSPERO 注册号：CRD42019131406。
