Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Ann Surg. 2020 Oct;272(4):590-594. doi: 10.1097/SLA.0000000000004378.
To compare a propensity-matched cohort of injured children receiving conventional blood component transfusion to injured children receiving low-titer group O negative whole blood.
Transfusion of whole blood in pediatric trauma patients is feasible and safe. Effectiveness has not been evaluated.
Injured children ≥1 years old can receive up to 40 mL/kg of cold-stored, uncrossmatched whole blood during initial hemostatic resuscitation. Whole blood recipients (2016-2019) were compared to a propensity-matched cohort who received at least 1 uncrossmatched red blood cell unit in the trauma bay (2013-2016). Cohorts were matched for age, hypotension, traumatic brain injury, injury mechanism, and need for emergent surgery. Outcomes included time to resolution of base deficit, product volumes transfused, and INR after resuscitation.
Twenty-eight children who received whole blood were matched to 28 children who received components. The whole blood group had faster time to resolution of base deficit [median (IQR) 2 (1-2.5) hours vs 6 (2-24) hours, respectively; P < 0.001]. The post-transfusion INR was decreased in whole blood vs component cohort [median (IQR) 1.4 (1.3-1.5) vs 1.6 (1.4-2.2); P = 0.01]. Lower plasma volumes [median (IQR) = 5 (0-15) mL/kg vs 11 (5-35) mL/kg; P = 0.04] and lower platelet volumes [median (IQR) = 0 (0-2) vs 3 (0-8); P = 0.03] were administered to the whole blood group versus component group. Other clinical variables (in-hospital death, hospital length of stay, intensive care unit length of stay, and ventilator days) did not differ between groups.
Compared to component transfusion, whole blood transfusion results in faster resolution of shock, lower post-transfusion INR, and decreased component product transfusion. Larger cohorts are required to support these findings.
比较接受常规血液成分输血的受伤儿童和接受低滴度 O 型阴性全血的受伤儿童的倾向匹配队列。
在儿科创伤患者中输注全血是可行且安全的。但尚未评估其效果。
年龄≥ 1 岁的受伤儿童在初始止血复苏期间可接受多达 40ml/kg 的冷藏、未交叉配血的全血。将全血接受者（2016-2019 年）与在创伤室接受至少 1 个未交叉配血的红细胞单位的倾向匹配队列进行比较（2013-2016 年）。队列按年龄、低血压、创伤性脑损伤、损伤机制和紧急手术需要进行匹配。结果包括碱缺失的缓解时间、输注的产品量和复苏后的 INR。
28 名接受全血的患儿与 28 名接受成分输血的患儿相匹配。全血组碱缺失缓解时间更快[中位数（IQR）分别为 2（1-2.5）小时和 6（2-24）小时；P < 0.001]。与成分输血组相比，全血组的输血后 INR 降低[中位数（IQR）分别为 1.4（1.3-1.5）和 1.6（1.4-2.2）；P = 0.01]。全血组给予的血浆量[中位数（IQR）= 5（0-15）ml/kg 与 11（5-35）ml/kg；P = 0.04]和血小板量[中位数（IQR）= 0（0-2）与 3（0-8）；P = 0.03]较低。两组的其他临床变量（院内死亡率、住院时间、重症监护病房时间和呼吸机天数）无差异。
与成分输血相比，全血输血可更快地缓解休克，降低输血后 INR，并减少成分产品的输注。需要更大的队列来支持这些发现。
