Analysis of Outcomes after Whole Blood Transfusion vs Balanced Component Therapy.

BACKGROUND

Whole blood (WB) transfusion is preferred to component therapy in hemorrhaging trauma patients. However, post-trauma complications with WB transfusion vs balanced component therapy (BCT) are not well studied. We sought to determine if WB transfusion results in decreased morbidity and mortality and hypothesized that WB transfusion would yield fewer complications.

STUDY DESIGN

Trauma Quality Improvement Program (TQIP) data from 2018-2021 were analyzed. Patients who received any volume of blood products within the first four hours were included. Patients <18 years old, with head or burn injuries, or missing demographic information were excluded. BCT was defined as 1:1:1 packed red blood cells:plasma:platelets, with only 1% difference between each component volume qualifying as balanced. Propensity matching was used to compare WB and BCT patients.

RESULTS

Before matching, there were 7,687 patients, 2,343 (30.48%) BCT and 5,344 (69.52%) WB. Post-propensity matching included 4,434 patients evenly distributed between BCT and WB groups. There were no differences in demographics between groups. The WB cohort had shorter intensive care unit (ICU) stays and significantly lower rates of acute kidney injury, acute respiratory distress syndrome, cardiac arrest, deep vein thrombosis, unplanned ICU admission, unplanned intubation, and unplanned surgery than BCT. There was no significant difference in in-hospital mortality between the two groups (p = 0.30).

CONCLUSIONS

WB transfusion was associated with fewer complications compared to BCT, but did not appear to be associated with improved survival. Further studies are needed to examine the mechanism driving lower incidence of complications with WB transfusion.