From the Department of Surgery (A.E.S., K.J.B., H.M.C.), Department of Emergency Medicine (R.J.C., N.C.N., J.H.), Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine (A.F., D.C.W., A.Z.), Department of Medicine Statistics Core (N.J.J., T.R., J.G.), David Geffen School of Medicine at UCLA, Los Angeles; and College of Medicine (S.J.L.), Touro University California, Vallejo, California.
J Trauma Acute Care Surg. 2021 Oct 1;91(4):655-662. doi: 10.1097/TA.0000000000003334.
This pilot assessed transfusion requirements during resuscitation with whole blood followed by standard component therapy (CT) versus CT alone, during a change in practice at a large urban Level I trauma center.
This was a single-center prospective cohort pilot study. Male trauma patients received up to 4 units of cold-stored low anti-A, anti-B group O whole blood (LTOWB) as initial resuscitation followed by CT as needed (LTOWB + CT). A control group consisting of women and men who presented when LTOWB was unavailable, received CT only (CT group). Exclusion criteria included antiplatelet or anticoagulant medication and death within 24 hours. The primary outcome was total transfusion volume at 24 hours. Secondary outcomes were mortality, morbidity, and intensive care unit- and hospital-free days.
Thirty-eight patients received LTOWB, with a median of 2.0 (interquartile range [IQR] 1.0-3.0) units of LTOWB transfused. Thirty-two patients received CT only. At 24 hours after presentation, the LTOWB +CT group had received a median of 2,138 mL (IQR, 1,275-3,325 mL) of all blood products. The median for the CT group was 4,225 mL (IQR, 1,900-5,425 mL; p = 0.06) in unadjusted analysis. When adjusted for Injury Severity Score, sex, and positive Focused Assessment with Sonography for Trauma, LTOWB +CT group patients received 3307 mL of blood products, and CT group patients received 3,260 mL in the first 24 hours (p = 0.95). The adjusted median ratio of plasma to red cells transfused was higher in the LTOWB + CT group (0.85 vs. 0.63 at 24 hours after admission; p = 0.043. Adjusted mortality was 4.4% in the LTOWB + CT group, and 11.7% in the CT group (p = 0.19), with similar complications, intensive care unit-, and hospital-free days in both groups.
Beginning resuscitation with LTOWB results in equivalent outcomes compared with resuscitation with CT only.
Therapeutic (Prospective study with 1 negative criterion, limited control of confounding factors), level III.
本研究在一家大型城市一级创伤中心改变实践的过程中，评估了在复苏时使用全血后再进行标准成分治疗（CT）与仅进行 CT 相比的输血需求。
这是一项单中心前瞻性队列研究。男性创伤患者接受多达 4 单位的冷藏低抗 A、抗 B 组 O 型全血（LTOWB）作为初始复苏，然后根据需要进行 CT（LTOWB+CT）。一个对照组由女性和男性组成，他们在 LTOWB 不可用时仅接受 CT（CT 组）。排除标准包括抗血小板或抗凝药物治疗以及 24 小时内死亡。主要结局是 24 小时内的总输血量。次要结局是死亡率、发病率以及重症监护病房和医院无天数。
38 名患者接受了 LTOWB，中位数为 2.0（四分位距 [IQR] 1.0-3.0）单位的 LTOWB 输血。32 名患者仅接受 CT。在就诊后 24 小时，LTOWB+CT 组接受了中位数为 2138mL（IQR，1275-3325mL）的所有血液制品。CT 组未调整分析的中位数为 4225mL（IQR，1900-5425mL；p=0.06）。当调整创伤重点超声评估的损伤严重程度评分、性别和阳性时，LTOWB+CT 组患者在 24 小时内接受了 3307mL 的血液制品，而 CT 组患者接受了 3260mL（p=0.95）。LTOWB+CT 组输注的血浆与红细胞中位数比值较高（入院后 24 小时为 0.85 比 0.63；p=0.043）。LTOWB+CT 组的调整死亡率为 4.4%，CT 组为 11.7%（p=0.19），两组的并发症、重症监护病房和医院无天数相似。
用 LTOWB 开始复苏与仅用 CT 复苏的结果相当。
治疗（有 1 个阴性标准的前瞻性研究，混杂因素的控制有限），III 级。
