Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Thromb Haemost. 2024 Jan;22(1):140-151. doi: 10.1016/j.jtha.2023.09.025. Epub 2023 Oct 4.
Low-titer group O whole blood (LTOWB) or component therapy (CT) may be used to resuscitate hemorrhaging trauma patients. LTOWB may have clinical and logistical benefits and may improve survival.
We hypothesized LTOWB would improve 24-hour survival in hemorrhaging patients and would be safe and equally efficacious in non-group O compared with group O patients.
Adult trauma patients with massive transfusion protocol activations were enrolled in this observational study. The primary outcome was 24-hour mortality. Secondary outcomes included 72-hour total blood product use. A Cox regression determined the independent associations with 24-hour mortality.
In total, 348 patients were included (CT, n = 180; LTOWB, n = 168). Demographics were similar between cohorts. Unadjusted 24-hour mortality was reduced in LTOWB vs CT: 8% vs 19% (P = .003), but 6-hour and 28-day mortality were similar. In an adjusted analysis with multivariable Cox regression, LTOWB was independently associated with reduced 24-hour mortality (hazard ratio, 0.21; 95% CI, 0.07-0.67; P = .004). LTOWB patients received significantly less 72-hour total blood products (80.9 [41.6-139.3] mL/kg vs 48.9 [25.9-106.9] mL/kg; P < .001). In stratified 24-hour survival analyses, LTOWB was associated with improved survival for patients in shock or with coagulopathy. LTOWB use in non-group O patients was not associated with increased mortality, organ injury, or adverse events.
In this hypothesis-generating study, LTOWB use was independently associated with improved 24-hour survival, predominantly in patients with shock or coagulopathy. LTOWB also resulted in a 40% reduction in blood product use which equates to a median 2.4 L reduction in transfused products.
低滴度 O 型全血（LTOWB）或成分治疗（CT）可用于复苏出血创伤患者。LTOWB 可能具有临床和后勤方面的优势，并可能提高存活率。
我们假设 LTOWB 会提高出血患者 24 小时的存活率，并且在非 O 型组与 O 型组患者相比，安全性和疗效相当。
本观察性研究纳入了接受大量输血方案激活的成年创伤患者。主要结局是 24 小时死亡率。次要结局包括 72 小时总血液制品的使用。Cox 回归确定了与 24 小时死亡率相关的独立因素。
共纳入 348 例患者（CT 组 n=180，LTOWB 组 n=168）。两组患者的人口统计学特征相似。未校正的 24 小时死亡率在 LTOWB 组较 CT 组降低：8% vs 19%（P=.003），但 6 小时和 28 天死亡率相似。在多变量 Cox 回归的调整分析中，LTOWB 与降低 24 小时死亡率独立相关（风险比，0.21；95%CI，0.07-0.67；P=.004）。LTOWB 组患者在 72 小时内接受的总血液制品明显较少（80.9 [41.6-139.3] mL/kg 比 48.9 [25.9-106.9] mL/kg；P<.001）。在分层的 24 小时生存分析中，LTOWB 与休克或凝血障碍患者的生存率提高相关。在非 O 型组患者中，LTOWB 的使用与死亡率、器官损伤或不良事件的增加无关。
在这项生成假设的研究中，LTOWB 的使用与 24 小时生存率的提高独立相关，主要是在休克或凝血障碍患者中。LTOWB 还使血液制品的使用减少了 40%，相当于输注产品中位数减少 2.4 L。
