Time to Whole Blood Transfusion in Hemorrhaging Civilian Trauma Patients: There Is Always Room for Improvement

Abstract

BACKGROUND: Whole blood (WB) is becoming the preferred product for the resuscitation of hemorrhaging trauma patients. However, there is a lack of data on the optimum timing of receiving WB. We aimed to assess the effect of time to WB transfusion on the outcomes of trauma patients. STUDY DESIGN: The American College of Surgeons TQIP 2017 to 2019 database was analyzed. Adult trauma patients who received at least 1 unit of WB within the first 2 hours of admission were included. Patients were stratified by time to first unit of WB transfusion (first 30 minutes, second 30 minutes, and second hour). Primary outcomes were 24-hour and in-hospital mortality, adjusting for potential confounders. RESULTS: A total of 1,952 patients were identified. Mean age and systolic blood pressure were 42 ± 18 years and 101 ± 35 mmHg, respectively. Median Injury Severity Score was 17 [10 to 26], and all groups had comparable injury severities (p = 0.27). Overall, 24-hour and in-hospital mortality rates were 14% and 19%, respectively. Transfusion of WB after 30 minutes was progressively associated with increased adjusted odds of 24-hour mortality (second 30 minutes: adjusted odds ratio [aOR] 2.07, p = 0.015; second hour: aOR 2.39, p = 0.010) and in-hospital mortality (second 30 minutes: aOR 1.79, p = 0.025; second hour: aOR 1.98, p = 0.018). On subanalysis of patients with an admission shock index >1, every 30-minute delay in WB transfusion was associated with higher odds of 24-hour (aOR 1.23, p = 0.019) and in-hospital (aOR 1.18, p = 0.033) mortality. CONCLUSIONS: Every minute delay in WB transfusion is associated with a 2% increase in odds of 24-hour and in-hospital mortality among hemorrhaging trauma patients. WB should be readily available and easily accessible in the trauma bay for the early resuscitation of hemorrhaging patients.

Timing to First Whole Blood Transfusion and Survival Following Severe Hemorrhage in Trauma Patients

“…The study concluded that WB transfusion after 30 minutes was associated with an increased odds of death at 24 hours and in the hospital. Taken together, the present study and the study by Hosseinpour et al suggest that timing is an important variable in survival associated with WB. However, several critical differences exist between the present study and the study of Hosseinpour et al First, the study by Hosseinpour et al included any patient who received WB without any additional physiological criteria or consideration for the need for MTP.…”

“…Taken together, the present study and the study by Hosseinpour et al suggest that timing is an important variable in survival associated with WB. However, several critical differences exist between the present study and the study of Hosseinpour et al First, the study by Hosseinpour et al included any patient who received WB without any additional physiological criteria or consideration for the need for MTP. Our study contributes to the narrative of these data, as it specifically evaluated patients with evidence of shock.…”

“…A recent study by Hosseinpour et al attempted to examine the association of time to WB transfusion with outcomes among injured patients. The authors conducted a retrospective analysis of adult trauma patients who received at least 1 unit of WB and stratified by time that the first unit of WB was transfused (first 30 minutes, second 30 minutes, and second hour).…”

Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: A Literature Review and Techniques to Help Clinicians Achieve Bleeding Control

“…Given that exsanguinating hemorrhage is a primary source of preventable early death among trauma victims, 31 - 34 the CAB approach is logically beneficial, because it addresses the more lethal problem first. In fact, timely resuscitation, preferably with whole blood as the first product, has been shown to significantly improve the outcomes of trauma patients with exsanguinating injury.…”