The Use of Whole Blood in Rural Trauma Leads to Decreased Resource Utilization

Niemann, Britney; Grabo, Daniel; Mullens, Cody L.; Shmookler, Aaron; Lopez, Santiago; Lander, Owen; Griffin, Peter L; Bardes, James M.

doi:10.1177/00031348221142584

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Hazelton et al 26 reported less bleeding complications in patients treated with SWB vs. BCT (OR, 0.91; 95% CI, 0.91–0.91; p < 0.001). Niemann et al 57 reported more ventilator associated pneumonia and pulmonary embolism in patients treated with WB ( p = 0.005).…”

Section: Resultsmentioning

confidence: 97%

“…Eighteen of 27 studies were retrospective with selection and confounding inherent in the design. Almost all studies had baseline differences including the seven prospective observational studies 21,23–27,57 . The two RCTs were mainly limited by their randomization processes, as blinding to the assigned intervention was not possible 22,48 .…”

Section: Resultsmentioning

confidence: 99%

“…Almost all studies had baseline differences including the seven prospective observational studies. 21,[23][24][25][26][27]57 The two RCTs were mainly limited by their randomization processes, as blinding to the assigned intervention was not possible. 22,48 In addition, the majority of the studies did not report on important cointerventions like crystalloid, tranexamic acid and fibrinogen administration.…”

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

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Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Horst

Rijnhout

Noorman³

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Whole blood (WB) transfusion received renewed interest after recent armed conflicts. The effectiveness as compared with blood component transfusion (BCT) is, however, still topic of debate. Therefore, this study investigated the effect of WB ± BCT as compared with BCT transfusion on survival in trauma patients with acute hemorrhage. METHODS Studies published up to January 16, 2023, including patients with traumatic hemorrhage comparing WB ± BCT and BCT were included in meta-analysis. Subanalyses were performed on the effectiveness of WB in the treatment of civilian or military trauma patients, patients with massive hemorrhage and on platelet (PLT)/red blood cell (RBC), plasma/RBC and WB/RBC ratios. Methodological quality of studies was interpreted using the Cochrane risk of bias tool. The study protocol was registered in PROSPERO under number CRD42022296900. RESULTS Random effect pooled odds ratio (OR) for 24 hours mortality in civilian and military patients treated with WB as compared with BCT was 0.72 (95% confidence interval [CI], 0.53–0.97). In subanalysis of studies conducted in civilian setting (n = 20), early (4 hours, 6 hours, and emergency department) and 24 hours mortality was lower in WB groups compared with BCT groups (OR, 0.65; 95% CI, 0.44–0.96 and OR, 0.71; 95% CI, 0.52–0.98). No difference in late mortality (28 days, 30 days, in-hospital) was found. In military settings (n = 7), there was no difference in early, 24 hours, or late mortality between groups. The WB groups received significant higher PLT/RBC (p = 0.030) during early treatment and significant higher PLT/RBC and plasma/RBC ratios during 24 hours of treatment (p = 0.031 and p = 0.007). The overall risk of bias in the majority of studies was judged as serious due to serious risk on confounding and selection bias, and unclear information regarding cointerventions. CONCLUSION Civilian trauma patients with acute traumatic hemorrhage treated with WB ± BCT as compared to BCT had lower odds on early and 24-hour mortality. In addition, WB transfusion resulted in higher PLT/RBC and plasma/RBC ratios. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level III.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Horst

Rijnhout

Noorman³

et al. 2023

J Trauma Acute Care Surg

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Blood banking services in critical access hospitals in Kansas: A laboratory perspective

Nuñez-Argote,

Corns,

Moser

2024

American Journal of Clinical Pathology

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Objectives To investigate the resource capacity for blood banking in critical access hospitals (CAHs) in Kansas and the experiences of medical laboratory personnel working in them. Methods An electronic survey was implemented to record data from all 82 CAHs in Kansas between May and July 2023. The distance between hospitals with no blood bank services and commercial blood banks was calculated. Results Only 63.4% of Kansas CAHs located in nonmetropolitan counties reported access to 24/7 blood bank services. In 12.2% of laboratories with 5 or fewer workers, there were no staff proficient in blood bank testing. While 72% of laboratories could perform type and screen and crossmatching, many lacked antibody identification capacity. Only 2 hospitals had the capacity to transfuse packed red blood cells, plasma, and platelets simultaneously if needed, with 20.6% of nonmetropolitan hospitals holding no blood products in inventory. Conclusions The blood banking capacity of CAHs in Kansas is influenced by the lack of workforce availability and training, reduced availability of blood products, and distance from facilities where blood is processed. Solutions tailored to the unique rural environment are needed to ensure adequate access to blood for patients.

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The Efficacy of Low-Titer Group O Whole Blood Compared With Component Therapy in Civilian Trauma Patients: A Meta-Analysis

Morgan,

Abou Khalil,

Feeney

et al. 2024

Critical Care Medicine

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Objectives: To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients. Data Sources: A systematic search of PubMed, CINAHL, and Web of Science was performed from their inception through December 1, 2023. Key terms included injury, hemorrhage, bleeding, blood transfusion, and whole blood. Study Selection: All studies comparing outcomes in injured civilian adults and children who received LTOWB versus CT were included. Data Extraction: Data including author, publication year, sample size, total blood volumes, and clinical outcomes were extracted from each article and reported following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Main outcomes were 24-hour (early) and combined 28-day, 30-day, and in-hospital (late) mortality rates between recipients of LTOWB versus CT, which were pooled using random-effects models. Data Synthesis: Of 1297 studies reviewed, 24 were appropriate for analysis. Total subjects numbered 58,717 of whom 5,164 received LTOWB. Eleven studies included adults-only, seven included both adults and adolescents, and six only included children. The median (interquartile range) age for patients who received LTOWB and CT was 35 years (24–39) and 35.5 years (23–39), respectively. Overall, 14 studies reported early mortality and 22 studies reported late mortality. LTOWB was associated with improved 24-hour survival (risk ratios [RRs] [95% CI] = 1.07 [1.03–1.12]) and late (RR [95% CI] = 1.05 [1.01–1.09]) survival compared with component therapy. There was no evidence of small study bias and all studies were graded as a moderate level of bias. Conclusions: These data suggest hemostatic resuscitation with LTOWB compared with CT improves early and late survival outcomes in bleeding civilian trauma patients. The majority of subjects were injured adults; multicenter randomized controlled studies in injured adults and children are underway to confirm these findings.

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The Use of Whole Blood in Rural Trauma Leads to Decreased Resource Utilization

Cited by 4 publications

References 13 publications

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Blood banking services in critical access hospitals in Kansas: A laboratory perspective

The Efficacy of Low-Titer Group O Whole Blood Compared With Component Therapy in Civilian Trauma Patients: A Meta-Analysis

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