与成分治疗相比，大量输注全血是安全的。
Large volume transfusion with whole blood is safe compared with component therapy.
机构信息
From the Department of Surgery (J.R.G.), University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Department of Surgery (A.D., A.C., M.G., E.D., A.G., M.S.), Oregon Health and Science University, Portland, Oregon.
出版信息
J Trauma Acute Care Surg. 2020 Jul;89(1):238-245. doi: 10.1097/TA.0000000000002687.
BACKGROUND
Transfusion with uncrossmatched cold-stored low-titer group O-positive or -negative whole blood (WB) in civilian trauma has been investigated as an alternative to component therapy but only in limited volumes. To our knowledge, this is the first analysis of the safety and efficacy of large volume transfusion of patients with trauma with WB.
METHODS
This is a retrospective cohort analysis comparing trauma patients resuscitated with component therapy (COMP) versus component therapy plus WB. The COMP group was comprised of patients who presented from January 2017 through June 2018 and the WB group from patients who presented from July 2018 through January 2019 after WB became available. We included patients if they received 1 unit of WB or red blood cells (RBCs) within 24 hours of admission and had massive transfusion protocol activated. We used bivariate analysis to compare groups. For analysis, one unit of WB equaled 1 unit of RBCs, 1 unit of plasma, and 1/6 of a unit of platelets.
RESULTS
Forty-two patients received WB and 83 patients received COMP with similar baseline characteristics. Patients had a median age of 41 years (interquartile range [IQR], 28-61 years) and 73% were male. Thirty percent had penetrating injuries with a median Injury Severity Score of 29 (IQR, 17-38). The WB group received a median of 6.5 units (IQR, 3-11). The WB group received significantly more component-equivalent units but with a plasma/RBC ratio of 0.94:1 compared with 0.8:1 (p < 0.001). There were no differences in 24-hour mortality (COMP, 27% vs. WB, 29%, p = 0.8) or 30-day mortality (COMP, 46% vs. WB, 58% p = 0.2). There were no transfusion reactions.
CONCLUSION
Transfusion utilizing primarily WB in civilian trauma is feasible, even in large volumes. It appears to be a safe and effective addition to component therapy and may lead to a more balanced resuscitation but with more overall product used.
LEVEL OF EVIDENCE
Therapeutic study, Level IV.
背景
在民用创伤中，输注未经交叉配型的冷藏低滴度 O 型阳性或阴性全血（WB）作为成分治疗的替代方法已被研究，但仅限于有限的容量。据我们所知，这是首次对大量输注 WB 的创伤患者的安全性和疗效进行分析。
方法
这是一项回顾性队列分析，比较了接受成分治疗（COMP）与 COMP 加 WB 的创伤患者。COMP 组纳入 2017 年 1 月至 2018 年 6 月期间入院的患者，WB 组纳入 2018 年 7 月至 2019 年 1 月期间入院的患者，该时间段内 WB 开始使用。我们纳入了在入院 24 小时内接受 1 单位 WB 或红细胞（RBC）输注且启动了大量输血方案的患者。我们使用双变量分析比较组间差异。对于分析，1 单位 WB 相当于 1 单位 RBC、1 单位血浆和 1/6 单位血小板。
结果
42 例患者接受 WB，83 例患者接受 COMP，两组患者基线特征相似。患者中位年龄为 41 岁（四分位距[IQR]，28-61 岁），73%为男性。30%的患者为穿透性损伤，损伤严重程度评分中位数为 29（IQR，17-38）。WB 组接受了中位数为 6.5 个单位（IQR，3-11）的治疗。与 COMP 组相比，WB 组接受了更多的成分当量单位，但血浆/RBC 比值为 0.94:1（p<0.001）。24 小时死亡率（COMP，27% vs. WB，29%，p=0.8）和 30 天死亡率（COMP，46% vs. WB，58%，p=0.2）无差异。无输血反应。
结论
在民用创伤中，主要使用 WB 输血是可行的，即使在大体积情况下也是如此。它似乎是成分治疗的安全有效补充，可能导致更平衡的复苏，但使用的总体产品更多。
证据水平
治疗性研究，IV 级。
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