全国范围内对民用创伤患者全血止血复苏的分析。
Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma.
机构信息
From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2):329-335. doi: 10.1097/TA.0000000000002753.
INTRODUCTION
Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.
METHODS
We analyzed the (2015-2016) Trauma Quality Improvement Program. We included adult (age, ≥18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.
RESULTS
A total of 8,494 patients were identified, of which 280 received WB-CT (WB, 1 [1-1]; pRBC, 16 [10-23]; FFP, 9 [6-16]; platelets, 3 [2-5]) and 8,214 received CT only (pRBC, 15 [10-24]; FFP, 10 [6-16]; platelets, 2 [1-4]). Mean ± SD age was 34 ± 16 years, 79% were male, Injury Severity Score was 33 (24-43), and 63% had penetrating injuries. Patients who received WB-CT had a lower 24-hour mortality (17% vs. 25%; p = 0.002), in-hospital mortality (29% vs. 40%; p < 0.001), major complications (29% vs. 41%; p < 0.001), and a shorter length of stay (9 [7-12] vs. 15 [10-21]; p = 0.011). On regression analysis, WB was independently associated with reduced 24-hour mortality (odds ratio [OR], 0.78 [0.59-0.89]; p = 0.006), in-hospital mortality (OR, 0.88 [0.81-0.90]; p = 0.011), and major complications (OR, 0.92 [0.87-0.96]; p = 0.013).
CONCLUSION
The use of WB as an adjunct to CT is associated with improved outcomes in resuscitation of severely injured civilian trauma patients. Further studies are required to evaluate the role of adding WB to massive transfusion protocols.
LEVEL OF EVIDENCE
Therapeutic, level IV.
简介
在军事上使用全血（WB）复苏后，人们对其在平民中的应用重新产生了兴趣。关于其在平衡成分治疗（CT）复苏为标准治疗的平民中的作用，数据很少。本研究的目的是评估在复苏平民创伤患者时，使用 WB 作为 CT 辅助治疗与单独使用 CT 的全国性结果。
方法
我们分析了（2015-2016）创伤质量改进计划。纳入了年龄≥18 岁、有出血性休克且在 4 小时内至少需要 1 单位浓缩红细胞（pRBC）的成年（成人）创伤患者。患者分为 WB-CT 组和 CT 组。主要结局是 24 小时和住院死亡率。次要结局是住院时间和主要并发症。为了考虑到医院内的聚类效应，并调整患者和医院水平的潜在混杂因素，我们进行了分层逻辑回归。
结果
共确定了 8494 名患者，其中 280 名接受了 WB-CT（WB，1[1-1]；pRBC，16[10-23]；FFP，9[6-16]；血小板，3[2-5]），8214 名仅接受 CT（pRBC，15[10-24]；FFP，10[6-16]；血小板，2[1-4]）。平均年龄为 34±16 岁，79%为男性，损伤严重程度评分 33（24-43），63%为穿透性损伤。接受 WB-CT 的患者 24 小时死亡率（17% vs. 25%；p=0.002）、住院死亡率（29% vs. 40%；p<0.001）、主要并发症（29% vs. 41%；p<0.001）和住院时间（9[7-12] vs. 15[10-21]；p=0.011）均较低。回归分析显示，WB 与降低 24 小时死亡率（比值比[OR]，0.78[0.59-0.89]；p=0.006）、住院死亡率（OR，0.88[0.81-0.90]；p=0.011）和主要并发症（OR，0.92[0.87-0.96]；p=0.013）独立相关。
结论
在严重创伤平民患者的复苏中，使用 WB 作为 CT 的辅助治疗与改善结局相关。需要进一步研究来评估在大量输血方案中添加 WB 的作用。
证据水平
治疗，IV 级。
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