Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries.
BACKGROUND
Increased understanding of the pathophysiology of the acute coagulopathy of trauma has lead many to question the current transfusion approach to hemorrhagic shock. We hypothesized that warm fresh whole blood (WFWB) transfusion would be associated with improved survival in patients with trauma compared with those transfused only stored component therapy (CT).


METHODS
We retrospectively studied US Military combat casualty patients transfused >or=1 unit of red blood cells (RBCs). The following two groups of patients were compared: (1) WFWB, who were transfused WFWB, RBCs, and plasma but not apheresis platelets and (2) CT, who were transfused RBC, plasma, and apheresis platelets but not WFWB. The primary outcomes were 24-hour and 30-day survival.


RESULTS
Of 354 patients analyzed there were 100 in the WFWB and 254 in the CT group. Patients in both groups had similar severity of injury determined by admission eye, verbal, and motor Glasgow Coma Score, base deficit, international normalized ratio, hemoglobin, systolic blood pressure, and injury severity score. Both 24-hour and 30-day survival were higher in the WFWB cohort compared with CT patients, 96 of 100 (96%) versus 223 of 254 (88%), (p = 0.018) and 95% to 82%, (p = 0.002), respectively. An increased amount (825 mL) of additives and anticoagulants were administered to the CT compared with the WFWB group, (p < 0.001). Upon multivariate logistic regression the use of WFWB and the volume of WFWB transfused was independently associated with improved 30-day survival.


CONCLUSIONS
In patients with trauma with hemorrhagic shock, resuscitation strategies that include WFWB may improve 30-day survival, and may be a result of less anticoagulants and additives with WFWB use in this population.
Spinella
Philip C
PC
United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. Pspinella@ccmckids.org
Perkins
Jeremy G
JG
Grathwohl
Kurt W
KW
Beekley
Alec C
AC
Holcomb
John B
JB
D000328:Adult; D055826:Afghan Campaign 2001-; D016913:Blood Component Transfusion; D001803:Blood Transfusion; D006801:Humans; D054542:Iraq War, 2003-2011; D053208:Kaplan-Meier Estimate; D008889:Military Personnel; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D014193:Trauma Centers; D014950:Wounds, Penetrating / Q000150:complications; D055815:Young Adult