University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Ann Surg. 2023 Apr 1;277(4):e919-e924. doi: 10.1097/SLA.0000000000005251. Epub 2021 Oct 8.
The aim of this study was to assess the survival impact of low-titer group O whole blood (LTOWB) in injured pediatric patients who require massive transfusion.
Limited data are available regarding the effectiveness of LTOWB in pediatric trauma.
A prospective observational study of children requiring massive transfusion after injury at UPMC Children's Hospital of Pittsburgh, an urban academic pediatric Level 1 trauma center. Injured children ages 1 to 17 years who received a total of >40 mL/kg of LTOWB and/or conventional components over the 24 hours after admission were included. Patient characteristics, blood product utilization and clinical outcomes were analyzed using Kaplan-Meier survival curves, log rank tests and Cox proportional hazards regression analyses. The primary outcome was 28-day survival.
Of patients analyzed, 27 of 80 (33%) received LTOWB as part of their hemostatic resuscitation. The LTOWB group was comparable to the component therapy group on baseline demographic and physiologic parameters except older age, higher body weight, and lower red blood cell and plasma transfusion volumes. After adjusting for age, total blood product volume transfused in 24 hours, admission base deficit, international normalized ratio (INR), and injury severity score (ISS), children who received LTOWB as part of their resuscitation had significantly improved survival at both 72 hours and 28 days post-trauma [adjusted odds ratio (AOR) 0.23, P = 0.009 and AOR 0.41, P = 0.02, respectively]; 6-hour survival was not statistically significant (AOR = 0.51, P = 0.30). Survivors at 28 days in the LTOWB group had reduced hospital LOS, ICU LOS, and ventilator days compared to the CT group.
Administration of LTOWB during the hemostatic resuscitation of injured children requiring massive transfusion was independently associated with improved 72-hour and 28-day survival.
本研究旨在评估低滴度 O 型全血（LTOWB）在需要大量输血的受伤儿科患者中的生存影响。
关于 LTOWB 在儿科创伤中的有效性的数据有限。
这是一项在匹兹堡大学医学中心儿童医院（一个城市学术儿科一级创伤中心）进行的受伤后需要大量输血的儿童的前瞻性观察研究。纳入年龄在 1 至 17 岁之间，入院后 24 小时内接受了>40 mL/kg 的 LTOWB 和/或常规成分的大量输血的受伤儿童。使用 Kaplan-Meier 生存曲线、对数秩检验和 Cox 比例风险回归分析患者特征、血液制品使用和临床结局。主要结局是 28 天生存率。
在分析的患者中，80 例患者中有 27 例（33%）接受了 LTOWB 作为其止血复苏的一部分。LTOWB 组与成分治疗组在基线人口统计学和生理参数上相似，除了年龄较大、体重较高、红细胞和血浆输注量较低。在校正年龄、24 小时内总血液制品输注量、入院基础缺陷、国际标准化比值（INR）和损伤严重程度评分（ISS）后，作为其复苏一部分接受 LTOWB 的儿童在创伤后 72 小时和 28 天的生存率显著提高[校正优势比（AOR）0.23，P=0.009 和 AOR 0.41，P=0.02]；6 小时生存率无统计学意义（AOR=0.51，P=0.30）。LTOWB 组在 28 天的幸存者与 CT 组相比，住院时间、重症监护病房时间和呼吸机天数减少。
在需要大量输血的受伤儿童的止血复苏过程中给予 LTOWB 与提高 72 小时和 28 天生存率独立相关。
