Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality.

Autor:	Sperry JL; From the Department of Surgery, University of Pittsburgh, Pittsburgh, PA (Sperry)., Cotton BA; Department of Surgery, University of Texas Health Science Center, Houston, TX (Cotton)., Luther JF; University of Pittsburgh School of Public Health, Pittsburgh, PA (Luther, Wisniewski)., Cannon JW; Department of Surgery, University of Pennsylvania, Philadelphia, PA (Cannon)., Schreiber MA; Department of Surgery, Oregon Health & Science University, Portland, OR (Schreiber)., Moore EE; Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado Health Sciences Center, Denver, CO (Moore)., Namias N; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL (Namias)., Minei JP; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Minei)., Wisniewski SR; University of Pittsburgh School of Public Health, Pittsburgh, PA (Luther, Wisniewski)., Guyette FX; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (Guyette).
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2023 Aug 01; Vol. 237 (2), pp. 206-219. Date of Electronic Publication: 2023 Apr 11.
DOI:	10.1097/XCS.0000000000000708
Abstrakt:	Background: Low-titer group O whole blood (LTOWB) resuscitation is becoming common in both military and civilian settings and may represent the ideal resuscitation intervention. We sought to characterize the safety and efficacy of LTOWB resuscitation relative to blood component resuscitation. Study Design: A prospective, multicenter, observational cohort study was performed using 7 trauma centers. Injured patients at risk of massive transfusion who required both blood transfusion and hemorrhage control procedures were enrolled. The primary outcome was 4-hour mortality. Secondary outcomes included 24-hour and 28-day mortality, achievement of hemostasis, death from exsanguination, and the incidence of unexpected survivors. Results: A total of 1,051 patients in hemorrhagic shock met all enrollment criteria. The cohort was severely injured with >70% of patients requiring massive transfusion. After propensity adjustment, no significant 4-hour mortality difference across LTOWB and component patients was found (relative risk [RR] 0.90, 95% CI 0.59 to 1.39, p = 0.64). Similarly, no adjusted mortality differences were demonstrated at 24 hours or 28 days for the enrolled cohort. When patients with an elevated prehospital probability of mortality were analyzed, LTOWB resuscitation was independently associated with a 48% lower risk of 4-hour mortality (relative risk [RR] 0.52, 95% CI 0.32 to 0.87, p = 0.01) and a 30% lower risk of 28-day mortality (RR 0.70, 95% CI 0.51 to 0.96, p = 0.03). Conclusions: Early LTOWB resuscitation is safe but not independently associated with survival for the overall enrolled population. When patients were selected with an elevated probability of mortality based on prehospital injury characteristics, LTOWB was independently associated with a lower risk of mortality starting at 4 hours after arrival through 28 days after injury. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Surgeons.)
Databáze:	MEDLINE
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