Timing to First Whole Blood Transfusion and Survival Following Severe Hemorrhage in Trauma Patients.

Autor:	Torres CM; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Kenzik KM; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Saillant NN; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Scantling DR; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Sanchez SE; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Brahmbhatt TS; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Dechert TA; Division of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts., Sakran JV; Johns Hopkins School of Medicine, Baltimore, Maryland.; Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland.; Johns Hopkins School of Nursing, Baltimore, Maryland.; Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2024 Apr 01; Vol. 159 (4), pp. 374-381.
DOI:	10.1001/jamasurg.2023.7178
Abstrakt:	Importance: Civilian trauma centers have revived interest in whole-blood (WB) resuscitation for patients with life-threatening bleeding. However, there remains insufficient evidence that the timing of WB transfusion when given as an adjunct to a massive transfusion protocol (MTP) is associated with a difference in patient survival outcome. Objective: To evaluate whether earlier timing of first WB transfusion is associated with improved survival at 24 hours and 30 days for adult trauma patients presenting with severe hemorrhage. Design, Setting, and Participants: This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program databank from January 1, 2019, to December 31, 2020, for adult patients presenting to US and Canadian adult civilian level 1 and 2 trauma centers with systolic blood pressure less than 90 mm Hg, with shock index greater than 1, and requiring MTP who received a WB transfusion within the first 24 hours of emergency department (ED) arrival. Patients with burns, prehospital cardiac arrest, deaths within 1 hour of ED arrival, and interfacility transfers were excluded. Data were analyzed from January 3 to October 2, 2023. Exposure: Patients who received WB as an adjunct to MTP (earlier) compared with patients who had yet to receive WB as part of MTP (later) at any given time point within 24 hours of ED arrival. Main Outcomes and Measures: Primary outcomes were survival at 24 hours and 30 days. Results: A total of 1394 patients met the inclusion criteria (1155 male [83%]; median age, 39 years [IQR, 25-51 years]). The study cohort included profoundly injured patients (median Injury Severity Score, 27 [IQR, 17-35]). A survival curve demonstrated a difference in survival within 1 hour of ED presentation and WB transfusion. Whole blood transfusion as an adjunct to MTP given earlier compared with later at each time point was associated with improved survival at 24 hours (adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P = .003). Similarly, the survival benefit of earlier WB transfusion remained present at 30 days (adjusted hazard ratio, 0.32; 95% CI, 0.22-0.45; P < .001). Conclusions and Relevance: In this cohort study, receipt of a WB transfusion earlier at any time point within the first 24 hours of ED arrival was associated with improved survival in patients presenting with severe hemorrhage. The survival benefit was noted shortly after transfusion. The findings of this study are clinically important as the earlier timing of WB administration may offer a survival advantage in actively hemorrhaging patients requiring MTP.
Databáze:	MEDLINE
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