The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan.
BACKGROUND
In Afghanistan, care of the acutely injured trauma patient commonly occurred in facilities with limited blood banking capabilities. Apheresis platelets were often not available. Component therapy consisted of 1:1 packed red blood cells and fresh frozen plasma. Fresh, whole blood transfusion often augmented therapy in the severely injured patient. This study analyzed the safety of fresh, whole blood use in a resource-limited setting.


METHODS
A retrospective analysis was performed on a prospectively collected data set of US battle injuries presenting to three US Marine Corps (USMC) expeditionary surgical care facilities in Helmand Province, Afghanistan, between January 2010 and July 2012. Included in the review were patients with Injury Severity Scores (ISSs) of 15 or higher receiving blood transfusions. Univariate analyses were performed, followed by multivariable logistic regression to describe the relationship between the treatment group and posttreatment complications such as trauma-induced coagulopathy, infection, mortality, venous thromboembolism, and transfusion reaction. Propensity scores were calculated and included in multivariable models to adjust for potential bias in treatment selection.


RESULTS
A total of 61 patients were identified; all were male marines with a mean (SD) age of 23.5 (3.6) years. The group receiving fresh, whole blood was noted to have higher ISSs and lower blood pressure, pH, and base deficits on arrival. Traumatic coagulopathy was significantly less common in the group receiving fresh, whole blood (odds ratio, 0.01; 95% confidence interval, 0.00-0.18). Multivariable models found no other significant differences between the treatment groups.


CONCLUSIONS
The early use of fresh, whole blood in a resource-limited setting seems to confer a benefit in reducing traumatic coagulopathy. This study's small sample size precludes further statement on the overall safety of fresh, whole blood use.


METHODS
Therapy study, level IV.
From the Naval Medical Center San Diego (J.D.A., N.L.L., R.M.G., C.B.D.); and Naval Health Research Center (J.L.H., M.R.G., T.J.Z.), San Diego, California; and Naval Medical Center Portsmouth (C.D.S.), Portsmouth, Virginia.
Jonathan D
JD
Auten
Nicole L
NL
Lunceford
Jaime L
JL
Horton
Mike R
MR
Galarneau
Roger M
RM
Galindo
Craig D
CD
Shepps
Tara J
TJ
Zieber
Chris B
CB
Dewing
D000328:Adult; D000346:Afghanistan; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000379:methods*; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D015999:Multivariate Analysis; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D065227:Transfusion Reaction; D016896:Treatment Outcome; D000067398:War-Related Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D014857:Warfare; D055815:Young Adult