Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association With Mortality.

IF 7.5 1区 医学 Q1 SURGERY
Annals of surgery Pub Date : 2024-12-01 Epub Date: 2024-05-06 DOI:10.1097/SLA.0000000000006316
Ander Dorken-Gallastegi, Phillip C Spinella, Matthew D Neal, Christine Leeper, Jason Sperry, Andrew B Peitzman, Joshua B Brown
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Abstract

Objective: To evaluate the interaction between whole blood (WB) and blood component resuscitation in relation to mortality after trauma.

Background: WB is increasingly available in civilian trauma resuscitation, and it is typically transfused concomitantly with blood components. The interaction between WB and blood component transfusions is unclear.

Methods: Adult patients with trauma with a shock index >1 who received ≥4 combined units of red blood cells and/or WB within 4 hours across 501 U.S. trauma centers were included using the American College of Surgeons Trauma Quality Improvement Program database. The associations between (1) WB resuscitation and mortality, (2) WB to total transfusion volume ratio (WB:TTV) and mortality, and (3) balanced blood component transfusion in the setting of combined WB and component resuscitation and mortality were evaluated with multivariable analysis.

Results: A total of 12,275 patients were included (WB: 2884 vs component-only: 9391). WB resuscitation was associated with lower odds of 4-hour [adjusted odds ratio: 0.81 (0.68-0.97)], 24-hour, and 30-day mortality compared with component-only. Higher WB:TTV ratios were significantly associated with lower 4-hour, 24-hour, and 30-day mortality, with a 13% decrease in odds of 4-hour mortality for each 10% increase in the WB:TTV ratio [0.87 (95% CI: 0.80-0.94)]. Balanced blood component transfusion was associated with significantly lower odds of 4-hour [adjusted odds ratio: 0.45 (95% CI: 0.29-0.68)], 24-hour, and 30-day mortality in the setting of combined WB and blood component resuscitation.

Conclusions: WB resuscitation, higher WB:TTV ratios, and balanced blood component transfusion in conjunction with WB were associated with lower mortality in patients with trauma presenting in shock requiring at least 4 units of red blood cells and/or WB transfusion within 4 hours of arrival.

创伤中的全血和血液成分复苏:与死亡率的相互作用和关联。
目的:评估全血(WB)和血液成分复苏在创伤后死亡率方面的相互作用:评估全血(WB)和血液成分复苏之间的相互作用与创伤后死亡率的关系:全血越来越多地应用于民用创伤复苏,通常与血液成分同时输注。WB 与输血成分之间的相互作用尚不清楚:方法:利用美国外科学院创伤质量改进项目(ACS-TQIP)数据库,纳入了美国 501 个创伤中心中休克指数大于 1 且在 4 小时内接受红细胞(RBC)或白细胞联合单位≥4 个的成人创伤患者。通过多变量分析评估了 1)红细胞复苏与死亡率;2)红细胞与总输血量比率(WB:TTV)与死亡率;3)在合并红细胞和成分复苏的情况下平衡输血成分与死亡率之间的关系:结果:共纳入了 12,275 例患者(WB:2,884 例,纯成分:9,391 例)。与单纯成分复苏相比,WB复苏与较低的4小时死亡率(调整赔率[aOR]:0.81 [0.68-0.97])、24小时死亡率和30天死亡率相关。WB:TTV 比率越高,4 小时、24 小时和 30 天死亡率越低,WB:TTV 比率每增加 10%,4 小时死亡率降低 13%(0.87 [95%CI:0.80 - 0.94])。在WB和血液成分联合复苏的情况下,均衡输血成分与4小时(aOR:0.45 [95%CI:0.29 - 0.68])、24小时和30天死亡率的显著降低相关:结论:对于需要在到达后 4 小时内输注 4 个单位红细胞和/或白细胞的休克创伤患者而言,白细胞复苏、较高的白细胞:TTV 比率以及在输注白细胞的同时输注平衡的血液成分与较低的死亡率相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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