Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

Abstract

Objective To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01–0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15–0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02–0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01–0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03–0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01–0.95; P = 0.05). Conclusions PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study.

Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: a multicentre cohort study

“…Early red blood cell transfusion following trauma might beneficially reduce the risk of coagulopathy. 51 Furthermore, trauma-induced coagulopathy increases the risk of major bleeding and use of 1:1:1 platelet:fresh frozen plasma:red blood cell has been advocated by some experts in the prevention or treatment of trauma-induced coagulopathy. However, few evidences support the use of such strategy.…”

Red Blood Cell Storage Duration and Trauma

“…The "Inflammation and the Host Response to Injury" collaborative (www.gluegrant.org), which is a large prospective cohort study of blunt-injured adult trauma patients with hemorrhagic shock, has taken further steps toward refinement of study criteria by developing standardized protocols to reduce variation in patient care across the 9 participating level 1 trauma centers in the United States [40,41]. Together with clearly defined patient selection criteria and standardized trauma care protocols, a database of some 2000 patients has been developed that includes comprehensive clinical information and results of immunological, biochemical, and molecular characterizations of the patient's biological responses after severe trauma.…”

Variability of Uncrossmatched Blood Use by Helicopter EMS Programs in the United States

“…9,17,18 Only more recently has some literature suggested improved outcomes for trauma patients who receive prehospital blood transfusion. 8,19 Of those programs that independently carry a supply of blood, most programs carry blood on all flights, while fewer first assess patient cases and then decide whether to bring blood on the transport based on specific criteria. One reason for carrying blood on a patient-dependent basis could be due to local blood bank or system regulations that place a constraint on blood use on HEMS transports.…”