Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
Public Health Sciences, Penn State College of Medicine, Hershey, PA.
Ann Surg. 2022 Oct 1;276(4):579-588. doi: 10.1097/SLA.0000000000005603. Epub 2022 Jul 18.
The aim of this study was to identify a mortality benefit with the use of whole blood (WB) as part of the resuscitation of bleeding trauma patients.
Blood component therapy (BCT) is the current standard for resuscitating trauma patients, with WB emerging as the blood product of choice. We hypothesized that the use of WB versus BCT alone would result in decreased mortality.
We performed a 14-center, prospective observational study of trauma patients who received WB versus BCT during their resuscitation. We applied a generalized linear mixed-effects model with a random effect and controlled for age, sex, mechanism of injury (MOI), and injury severity score. All patients who received blood as part of their initial resuscitation were included. Primary outcome was mortality and secondary outcomes included acute kidney injury, deep vein thrombosis/pulmonary embolism, pulmonary complications, and bleeding complications.
A total of 1623 [WB: 1180 (74%), BCT: 443(27%)] patients who sustained penetrating (53%) or blunt (47%) injury were included. Patients who received WB had a higher shock index (0.98 vs 0.83), more comorbidities, and more blunt MOI (all P <0.05). After controlling for center, age, sex, MOI, and injury severity score, we found no differences in the rates of acute kidney injury, deep vein thrombosis/pulmonary embolism or pulmonary complications. WB patients were 9% less likely to experience bleeding complications and were 48% less likely to die than BCT patients ( P <0.0001).
Compared with BCT, the use of WB was associated with a 48% reduction in mortality in trauma patients. Our study supports the use of WB use in the resuscitation of trauma patients.
本研究旨在确定使用全血（WB）作为出血性创伤患者复苏的一部分是否具有生存获益。
血液成分治疗（BCT）是目前复苏创伤患者的标准方法，而 WB 作为首选血液制品出现。我们假设使用 WB 与单独使用 BCT 相比会降低死亡率。
我们进行了一项 14 中心、前瞻性观察性研究，纳入了接受 WB 与 BCT 复苏的创伤患者。我们应用了具有随机效应的广义线性混合效应模型，并控制了年龄、性别、损伤机制（MOI）和损伤严重程度评分。所有接受血液作为初始复苏一部分的患者均被纳入。主要结局是死亡率，次要结局包括急性肾损伤、深静脉血栓形成/肺栓塞、肺部并发症和出血并发症。
共纳入 1623 例（WB：1180 例[74%]，BCT：443 例[27%]）穿透性（53%）或钝性（47%）损伤的患者。接受 WB 的患者休克指数更高（0.98 比 0.83），合并症更多，钝性 MOI 更常见（均 P<0.05）。在控制中心、年龄、性别、MOI 和损伤严重程度评分后，我们发现急性肾损伤、深静脉血栓形成/肺栓塞或肺部并发症的发生率无差异。WB 患者发生出血并发症的可能性降低 9%，死亡的可能性降低 48%，低于 BCT 患者（P<0.0001）。
与 BCT 相比，在创伤患者的复苏中使用 WB 与降低 48%的死亡率相关。我们的研究支持在创伤患者的复苏中使用 WB。
