将全血纳入失血性休克复苏的影响：对1377例连续接受紧急放行未交叉配血血液制品的创伤患者的分析。
Impact of Incorporating Whole Blood into Hemorrhagic Shock Resuscitation: Analysis of 1,377 Consecutive Trauma Patients Receiving Emergency-Release Uncrossmatched Blood Products.
作者信息
Brill Jason B, Tang Brian, Hatton Gabrielle, Mueck Krislynn M, McCoy C Cameron, Kao Lillian S, Cotton Bryan A
机构信息
From The McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX (Brill, Tang, Hatton, Mueck, Kao, Cotton).
The University of Kansas Medical Center, Kansas City, KS (McCoy).
出版信息
J Am Coll Surg. 2022 Apr 1;234(4):408-418. doi: 10.1097/XCS.0000000000000086.
BACKGROUND
Use of whole blood (WB) for trauma resuscitation has seen a resurgence. The purpose of this study was to investigate survival benefit of WB across a diverse population of bleeding trauma patients.
STUDY DESIGN
A prospective observational cohort study of injured patients receiving emergency-release blood products was performed. All adult trauma patients resuscitated between November 2017 and September 2020 were included. The WB group included patients receiving any group O WB units. The component (COMP) group received no WB units, instead relying on fractionated blood (red blood cells, plasma, and platelets). Univariate and multivariate analyses were performed. Given large observed differences in our regression model, post hoc adjustments with inverse probability of treatment were conducted and a propensity score created. Propensity scoring and Poisson regression supported these findings.
RESULTS
Of 1,377 patients receiving emergency release blood products, 840 received WB and 537 remained in the COMP arm. WB patients had higher Injury Severity Score (ISS; 27 vs 20), lower field blood pressure (103 vs 114), and higher arrival lactate (4.2 vs 3.5; all p < 0.05). Postarrival transfusions and complications were similar between groups, except for sepsis, which was lower in the WB arm (25 vs 30%, p = 0.041). Although univariate analysis noted similar survival between WB and COMP (75 vs 76%), logistic regression found WB was independently associated with a 4-fold increased survival (odds ratio [OR] 4.10, p < 0.001). WB patients also had a 60% reduction in overall transfusions (OR 0.38, 95% CI 0.21-0.70). This impact on survival remained regardless of location of transfusion, ISS, or presence of head injury.
CONCLUSION
In patients experiencing hemorrhagic shock, WB transfusion is associated with both improved survival and decreased overall blood utilization.
背景
全血（WB）用于创伤复苏的情况再度兴起。本研究的目的是调查全血在不同类型出血性创伤患者群体中的生存获益情况。
研究设计
对接受紧急发放血液制品的受伤患者进行了一项前瞻性观察队列研究。纳入了2017年11月至2020年9月期间接受复苏的所有成年创伤患者。全血组包括接受任何O型全血单位的患者。成分血（COMP）组未接受全血单位，而是依赖于成分血（红细胞、血浆和血小板）。进行了单因素和多因素分析。鉴于我们回归模型中观察到的较大差异，进行了治疗逆概率的事后调整并创建了倾向评分。倾向评分和泊松回归支持了这些发现。
结果
在1377例接受紧急发放血液制品的患者中，840例接受了全血，537例留在成分血组。全血组患者的损伤严重程度评分（ISS）更高（27分对20分），现场血压更低（103对114），到达时乳酸水平更高（4.2对3.5；所有p<0.05）。两组到达后的输血情况和并发症相似，但败血症在全血组中较低（25%对30%，p=0.041）。尽管单因素分析指出全血组和成分血组的生存率相似（75%对76%），但逻辑回归发现全血与生存率提高4倍独立相关（比值比[OR]4.10，p<0.001）。全血组患者的总输血量也减少了60%（OR 0.38，95%CI 0.21-0.70）。无论输血地点、ISS或是否存在头部损伤，这种对生存的影响均持续存在。
结论
在发生失血性休克的患者中，输注全血与生存率提高和总血液利用率降低均相关。
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