The use of low‐titer group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage
| Autor: | Philip C. Spinella, Callista Martin, Susan M. Shea, Kimberly A. Thomas, Ethan Lowder, Grant V. Bochicchio, James E Mielke, Danielle Folkerts, Douglas J. E. Schuerer, Amanda M Staudt |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Immunology Blood Component Transfusion Hemorrhage 030204 cardiovascular system & hematology Logistic regression Severity of Illness Index ABO Blood-Group System Young Adult 03 medical and health sciences 0302 clinical medicine Blood product Organ Dysfunction Scores Internal medicine medicine Humans Immunology and Allergy Blood Transfusion Hospital Mortality Prospective Studies Survival analysis Proportional Hazards Models business.industry Proportional hazards model Organ dysfunction Hematology Odds ratio Confidence interval Survival Rate Logistic Models Wounds and Injuries Female medicine.symptom business 030215 immunology |
| Zdroj: | Transfusion. 60 |
| ISSN: | 1537-2995 0041-1132 |
| DOI: | 10.1111/trf.15696 |
| Popis: | BACKGROUND There is a resurgence in the use of low-titer group O whole blood (LTOWB) for hemorrhagic shock. We hypothesized the use of LTOWB compared to component therapy (CT) would be independently associated with improved 24-hour mortality. STUDY DESIGN AND METHODS In this prospective observational study, trauma patients 18 years of age or older with massive transfusion protocol activations were included from August 17, 2018, to May 14, 2019. The primary outcome was 24-hour mortality. Secondary outcomes included 72-hour blood product totals, multiple organ dysfunction scores (MODS), and 28-day mortality. Multivariable logistic regression (MVLR) and Cox regression were performed to determine independent associations. RESULTS There were no clinically meaningful differences in measures of injury severity between study groups (CT, n = 42; LTOWB, n = 44). There was no difference in MODS between study groups. The unadjusted mortality was not statistically different between the study groups (9/42 [21%] for CT vs. 7/44 [16%] for LTOWB; p = 0.518). In the MVLR model, LTOWB increased the odds of 24-hour survival by 23% (odds ratio 0.81, 95% confidence interval 0.69-0.96; p = 0.017). Adjusted survival curve analysis indicated improved survival at both 24 hours and 28 days for LTOWB patients (p < 0.001). Further stratification showed an association between LTOWB use and survival when maximum clot firmness (MCF) was 60 mm or less (p = 0.009). CONCLUSIONS The use of LTOWB is independently associated with improved 24-hour and 28-day survival, and does not increase organ dysfunction at 72 hours. Use of LTOWB most impacted survival of patients with reduced clot firmness (MCF ≤60 mm). Collectively, these data support the clinical use and continued study of LTOWB for hemostatic resuscitation. |
| Databáze: | OpenAIRE |
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