Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties

Gurney, Jennifer M; Staudt, Amanda M; Junco, Deborah J. del; Shackelford, Stacy; Mann-Salinas, Elizabeth; Andrew, P.; Spinella, Philip C.; Martin, Matthew J.

doi:10.1016/j.surg.2021.05.051

Cited by 47 publications

(52 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, there may be a dosedependent effect where higher numbers of WB transfusion result in an increase in transfusion reactions, though recent military data studying the effects of warm fresh WB are promising. 30 This result could not be elucidated from our study due to the low number of WB units transfused per patient. In conclusion, cold-stored WB used in the resuscitation of trauma patients was associated with decreased mortality, without an increase in complications compared with BCT alone.…”

Section: Discussionmentioning

confidence: 72%

Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding

Hazelton

Ssentongo

et al. 2022

Annals of Surgery

Self Cite

View full text Add to dashboard Cite

Objective: The aim of this study was to identify a mortality benefit with the use of whole blood (WB) as part of the resuscitation of bleeding trauma patients. Background: Blood component therapy (BCT) is the current standard for resuscitating trauma patients, with WB emerging as the blood product of choice. We hypothesized that the use of WB versus BCT alone would result in decreased mortality. Methods: We performed a 14-center, prospective observational study of trauma patients who received WB versus BCT during their resuscitation. We applied a generalized linear mixed-effects model with a random effect and controlled for age, sex, mechanism of injury (MOI), and injury severity score. All patients who received blood as part of their initial resuscitation were included. Primary outcome was mortality and secondary outcomes included acute kidney injury, deep vein thrombosis/pulmonary embolism, pulmonary complications, and bleeding complications. Results: A total of 1623 [WB: 1180 (74%), BCT: 443(27%)] patients who sustained penetrating (53%) or blunt (47%) injury were included. Patients who received WB had a higher shock index (0.98 vs 0.83), more comorbidities, and more blunt MOI (all P<0.05). After controlling for center, age, sex, MOI, and injury severity score, we found no differences in the rates of acute kidney injury, deep vein thrombosis/pulmonary embolism or pulmonary complications. WB patients were 9% less likely to experience bleeding complications and were 48% less likely to die than BCT patients (P<0.0001). Conclusions: Compared with BCT, the use of WB was associated with a 48% reduction in mortality in trauma patients. Our study supports the use of WB use in the resuscitation of trauma patients.

show abstract

Section: Discussionmentioning

confidence: 72%

Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding

Hazelton

Ssentongo

et al. 2022

Annals of Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, the demand for whole blood is still out‐pacing collections and surgical teams continue to rely on U.S. FDA‐licensed blood components or to untested emergency whole blood. In many instances, surgeons are choosing the untested whole blood over component therapy, based on available published data 31 and their clinical judgment of product efficacy in resuscitation 32 . New technologies to rapidly detect or treat and inactivate pathogens would mitigate the current risk profile of untested blood.…”

Section: Discussionmentioning

confidence: 99%

The U.S. Armed Services Blood Program support to U.S. Central Command 2014–2021: Transformation of combat trauma resuscitation through blood product innovation and expansion of blood availability far forward

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background The United States Armed Services Blood Program (ASBP) faced complex blood supply challenges during two decades of military operations in the U.S. Central Command (CENTCOM) and through an adaptive, responsive, and agile system, gained valuable insights on blood product usage in combat casualty care. Study Design and Methods A retrospective review of blood product introduction and utilization trends was compiled from ASBP data collected during CENTCOM operations from 2014 through 2021. Results During the study period, several blood products were introduced to the CENTCOM area of operations including Low Titer O Whole Blood (LTOWB), Cold‐Stored Platelets (CSP), Liquid Plasma (LP), and French Freeze Dried Plasma (FDP) manufactured from U.S. sourced donor plasma, all while expanding Walking Blood Bank capabilities. There was a gradual substitution of component therapy for whole blood; blood utilization peaked in 2017. Transfusion of Fresh Whole Blood (FWB) from Walking Blood Banks decreased as fully pre‐tested LTOWB was supplied by the ASBP. LTOWB was initially supplied in citrate–phosphate‐dextrose (CPD) anticoagulant (21‐day shelf life) but was largely replaced with LTOWB in citrate–phosphate‐dextrose‐adenine (CPDA‐1) anticoagulant (35‐day shelf life) by 2019. Implementation of prehospital transfusion and expansion of surgical and resuscitation teams led to an increase in the number of sites receiving blood. Discussion ASBP introduced new products to its inventory in order to meet changing blood product demands driven by changes in the Joint Trauma System Clinical Practice Guidelines and operational demands. These products were adopted into clinical practice with a resultant evolution in transfusion strategies.

show abstract

“…Military and humanitarian surgical teams often rely on a walking blood bank (WBB) to provide blood for trauma casualties. A WBB may be activated for reasons including the surgical team is running out of blood products, there is a lack of a certain component (eg, platelets are not available at Role 2 MTF), or a surgeon believes that warm fresh whole blood will help save a severely injured casualty’s life 28. While component therapy is a limited resource and resupply can be a challenge, the WBB has analogous limitations based the donor pool.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objective: To characterize humanitarian trauma care delivered by US military treatment facilities (MTFs) in Afghanistan and Iraq during combat operations. Background: International Humanitarian Law, which includes the Geneva Conventions, defines protections and standards of treatment to victims of armed conflicts. In 1949, these standards expanded to include injured civilians. In 2001, the Global War on Terror began in Afghanistan and expanded to Iraq in 2003. US MTFs provided care to all military forces, civilians, and enemy prisoners. A thorough understanding of the scope, epidemiology, resource requirements, and outcomes of civilian trauma in combat zones has not been previously characterized. Methods: Retrospective cohort analysis of the Department of Defense Trauma Registry from 2005 to 2019. Inclusion criteria were civilians and Non–North Atlantic Treaty Organization (NATO) Coalition Personnel (NNCP) with traumatic injuries treated at MTFs in Afghanistan and Iraq. Patient demographics, mechanism of injury, resource requirements, procedures, and outcomes were categorized. Results: A total of 29,963 casualties were eligible from the Registry. There were 16,749 (55.9%) civilians and 13,214 (44.1%) NNCP. The majority of patients were age above 13 years [26,853 (89.6%)] and male [28,000 (93.4%)]. Most injuries were battle-related: 12,740 (76.1%) civilians and 11,099 (84.0%) NNCP. Penetrating trauma was the most common cause of both battle and nonbattle injuries: 12,293 (73.4%) civilian and 10,029 (75.9%) NNCP. Median Injury Severity Score (ISS) was 9 in each cohort with ISS≥25 in 2236 (13.4%) civilians and 1398 (10.6%) NNCP. Blood products were transfused to 35% of each cohort: 5850 civilians received a transfusion with 2118 (12.6%) of them receiving ≥10 units; 4590 NNCPs received a transfusion with 1669 (12.6%) receiving ≥10 units. MTF mortality rates were civilians 1263 (7.5%) and NNCP 776 (5.9%). Interventions, both operative and nonoperative, were similar between both groups. Conclusions: In accordance with International Humanitarian Law, as well as the US military’s medical rules of eligibility, civilians injured in combat zones were provided the same level of care as NNCP. Injured civilians and NNCP had similar mechanisms of injury, injury patterns, transfusion needs, and ISS. This analysis demonstrates resource equipoise in trauma care delivered to civilians and NNCP. Hospitals in combat zones must be prepared to manage large numbers of civilian casualties with significant human and material resources allocated to optimize survival. The provision of humanitarian trauma care is resource-intensive, and these data can be used to inform planning factors for current or future humanitarian care in combat zones.

show abstract

Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties

Cited by 47 publications

References 39 publications

Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding

Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding

The U.S. Armed Services Blood Program support to U.S. Central Command 2014–2021: Transformation of combat trauma resuscitation through blood product innovation and expansion of blood availability far forward

Characterization of Humanitarian Trauma Care by US Military Facilities During Combat Operations in Afghanistan and Iraq

Contact Info

Product

Resources

About