院前使用较年轻个体的全血与改善的到达时凝血特征相关。
The prehospital use of younger age whole blood is associated with an improved arrival coagulation profile.
机构信息
From the Cumming School of Medicine (T.C., S.A.), University of Calgary; Center of Translational Injury Research and the Department of Surgery, McGovern Medical School (C.M., J.C., C.W., D.M., B.A.C.), University of Texas Health Science Center, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2021 Apr 1;90(4):607-614. doi: 10.1097/TA.0000000000003058.
INTRODUCTION
Recent in vitro data have shown that the hemostatic profile of whole blood (WB) degrades significantly after 14 days, yet the optimal storage remains debated. We hypothesized that arrival coagulation studies would be improved in patients receiving younger WB in the prehospital setting.
METHODS
This study was approved by our institutional institutional review board. We evaluated all trauma patients who received prehospital blood products by our helicopter service between July 2017 and July 2019. "Young" WB was defined as 14 days or less. Patients who received at least 1 U of young WB were classified as YOUNG, while the remainder was classified as OLD. Continuous data are presented as medians (25th-75th interquartile range) with comparisons performed using Wilcoxon rank sum. Assessments of clinical hemostatic potential included arrival platelet cell count and rapid thrombelastography. Multivariate regression analysis was also performed (Stata 12.1; College Station, TX).
RESULTS
A total of 220 patients received prehospital WB during the study period. Of these, 153 patients received YOUNG WB, while 67 were transfused only OLD WB units. There were no differences in demographics, prehospital or arrival physiology, or Injury Severity Score among the two groups. The measures of clot initiation (activated clotting time) and kinetics (k time) were improved, as were the measures of clot acceleration/fibrinogen function (angle) and platelet function (maximum amplitude). As well, arrival platelet count was higher in the YOUNG cohort. No significant differences in postarrival transfusion were noted (p = 0.220). Multivariate analysis showed the greatest differences in maximum amplitude and α angle but failed to reach significance.
CONCLUSION
Previous in vitro data have suggested deterioration of platelet function in cold-stored WB after 14 days. The current study demonstrated decreased global hemostasis by clinically available laboratory tests, especially related to fibrinogen and platelet interactions on univariate, but not multivariate analysis. This did not translate into increased transfusion requirements. Further studies are needed to determine the optimal storage duration for cold-stored WB for transfusion in the bleeding trauma patient, as well as rule out the presence of confounding variables.
LEVEL OF EVIDENCE
Therapeutic, level IV.
简介
最近的体外数据表明，全血（WB）的止血谱在 14 天后显著下降，但最佳储存方式仍存在争议。我们假设在院前环境中接受年轻 WB 的患者到达时的凝血研究将得到改善。
方法
本研究得到了我们机构审查委员会的批准。我们评估了 2017 年 7 月至 2019 年 7 月期间通过我们的直升机服务接受院前血液制品的所有创伤患者。“年轻”WB 定义为 14 天或更短。接受至少 1U 年轻 WB 的患者被归类为 YOUNG，其余患者被归类为 OLD。连续数据以中位数（25-75 百分位间距）表示，使用 Wilcoxon 秩和检验进行比较。对临床止血潜力的评估包括到达时血小板细胞计数和快速血栓弹性描记术。还进行了多变量回归分析（Stata 12.1；德克萨斯州 College Station）。
结果
在研究期间，共有 220 名患者接受了院前 WB。其中，153 名患者接受了 YOUNG WB，而 67 名患者仅输注 OLD WB 单位。两组患者在人口统计学、院前或到达时的生理状况或损伤严重程度评分方面无差异。凝块起始（活化凝血时间）和动力学（k 时间）的测量得到改善，凝块加速/纤维蛋白原功能（角度）和血小板功能（最大振幅）的测量也得到改善。此外，YOUNG 组的到达时血小板计数较高。到达后输血无显著差异（p=0.220）。多变量分析显示最大振幅和α角的差异最大，但未达到显著性。
结论
以前的体外数据表明，14 天后冷藏 WB 中的血小板功能会恶化。本研究通过临床可用的实验室测试显示了整体止血功能的降低，特别是与纤维蛋白原和血小板相互作用有关，在单变量分析中，但在多变量分析中没有达到显著性。这并没有转化为增加输血需求。需要进一步研究确定冷储存 WB 用于出血性创伤患者输血的最佳储存时间，以及排除混杂变量的存在。
证据水平
治疗性，IV 级。
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