Stettler Gregory R, Warner Rachel, Bouldin Bethany, Painter Matthew D, Avery Martin D, Hoth James J, Meredith J Wayne, Miller Preston R, Nunn Andrew M
Department of Surgery, Division of Trauma and Acute Care Surgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, NC, USA.
Department of Surgery, Division of Acute Care Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
Injury. 2025 Jan;56(1):111758. doi: 10.1016/j.injury.2024.111758. Epub 2024 Jul 31.
Older patients are expected to comprise 40 % of trauma admissions in the next 30 years. The use of whole blood (WB) has shown promise in improving mortality while lowering the utilization of blood products. However, the use of WB in older trauma patients has not been examined. The objective of our study is to determine the safety and efficacy of a WB first transfusion strategy in injured older patients.
Older trauma patients, defined as age ≥55 years old, were reviewed from March 2016-November 2021. Patients that received a WB first resuscitation strategy were compared to those that received a ratio based component strategy. Demographics as well as complications rates, blood product transfusion volumes, and mortality were evaluated. Univariate and multivariable analysis was used to determine independent predictors of mortality.
There were 388 older trauma patients that received any blood products during the study period. A majority of patients received a WB first resuscitation strategy (83 %). Compared to patients that received component therapy, patients that received WB first were more likely female, less likely to have a penetrating mechanism, and had a slightly lower injury severity score. The-30 day mortality rate was comparable (WB 36% vs component 37 %, p = 0.914). While rates of AKI were slightly higher in those that received WB, this did not result in increased rates of renal replacement therapy (3 % vs 2 %, p = 1). Further, compared to patients that received components, patients that were resuscitated with a WB first strategy significantly utilized lower median volumes of platelets (0 mL vs 197 mL, p < 0.001), median volumes of plasma (0 mL vs 1253 mL, p < 0.001, and median total volume of blood products (1000 mL vs 2859 mL, p < 0.001).
The use of WB in the older trauma patient appears safe, with mortality and complication rates comparable to component therapy. Blood product utilization is significantly less in those that are resuscitated with WB first.
预计在未来30年，老年患者将占创伤入院患者的40%。使用全血（WB）在提高死亡率的同时降低血液制品的使用率方面已显示出前景。然而，全血在老年创伤患者中的应用尚未得到研究。我们研究的目的是确定全血优先输血策略在老年创伤患者中的安全性和有效性。
回顾2016年3月至2021年11月期间年龄≥55岁的老年创伤患者。将接受全血优先复苏策略的患者与接受基于比例的成分输血策略的患者进行比较。评估人口统计学以及并发症发生率、血液制品输血量和死亡率。采用单变量和多变量分析来确定死亡率的独立预测因素。
在研究期间，有388名老年创伤患者接受了任何血液制品。大多数患者接受了全血优先复苏策略（83%）。与接受成分输血治疗的患者相比，接受全血优先输血的患者女性居多，穿透性损伤机制的可能性较小，损伤严重程度评分略低。30天死亡率相当（全血组为36%，成分输血组为37%，p = 0.914）。虽然接受全血输血的患者急性肾损伤发生率略高，但这并未导致肾脏替代治疗率增加（3%对2%，p = 1）。此外，与接受成分输血的患者相比，采用全血优先策略复苏的患者血小板中位数使用量显著降低（0 mL对197 mL，p < 0.001），血浆中位数使用量显著降低（0 mL对1253 mL，p < 0.001），血液制品总中位数使用量显著降低（1000 mL对2859 mL，p < 0.001）。
在老年创伤患者中使用全血似乎是安全的，死亡率和并发症发生率与成分输血治疗相当。首先使用全血进行复苏的患者血液制品使用率显著更低。
