Whole Blood for Resuscitation of Traumatic Hemorrhagic Shock in Adults

Jones, Allison R.; Miller, James; Jansen, Jan O.; Wang, Henry E.

doi:10.1097/tme.0000000000000376

Cited by 12 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In keeping with most prior studies in adults and children, we did not see an association between whole blood and mortality. 8,37 As of this writing, only one single-center study has demonstrated improved survival with whole blood resuscitation in children. 38 This study is not without limitations.…”

Section: Discussionmentioning

confidence: 99%

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

McLoughlin,

Josephson,

Neff

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

Purpose Balanced blood product resuscitation with red blood cells, plasma, and platelets can be achieved using whole blood (WB) or component therapy (CT). However, balanced resuscitation of younger children with severe traumatic hemorrhage may be complicated by delays in delivering all blood components and concerns regarding multiple product exposures. We hypothesized that WB achieves balanced resuscitation faster than CT, with fewer product exposures and improved clinical outcomes. Methods Children <12 years old receiving balanced resuscitation within four hours of arrival were identified from the 2017-2019 Trauma Quality Improvement Program database. Time to balanced resuscitation was defined as the time of initiation of WB or all three components. Patient characteristics, resuscitation details, and outcomes were compared between WB and CT groups. Time to balanced resuscitation was compared using Kaplan-Meier analysis and Cox regression modeling to adjust for covariates. Additional multivariable regression models compared number of transfusion exposures, intensive care unit (ICU) length of stay, and mortality. Results There were 390 patients (109 WB, 281 CT) with median age 7 years, 12% penetrating mechanism, 42% severe TBI, and 49% in-hospital mortality. Time to balanced resuscitation was shorter for WB vs. CT (median 28 vs. 87 minutes, hazard ratio [HR] 2.93, 95% confidence interval [CI] 2.31-3.72, p < 0.0001). WB patients received fewer transfusion exposures (mean 3.2 vs. 3.9, adjusted incidence rate ratio 0.82, 95% CI 0.72-0.92, p = 0.001) and lower total product volumes (50 vs. 85 mL/kg, p = 0.01). ICU stays trended shorter for WB vs. CT (median 10 vs. 12 days; adjusted HR 1.32, 95% CI 0.93-1.86), while in-hospital mortality was similar (50% vs. 45%, adjusted odds ratio 1.11, 95% CI 0.65-1.88). Conclusions In critically injured pre-adolescent children receiving emergent transfusion, WB was associated with faster time to balanced resuscitation, fewer transfusion exposures, lower blood product volumes, and a trend toward shorter ICU stays than CT. Study Type Original Research Level of Evidence 3, retrospective

show abstract

Section: Discussionmentioning

confidence: 99%

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

McLoughlin,

Josephson,

Neff

et al. 2023

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Time in storage is a critical factor influencing platelet activity 8 . Whole blood transfusion is an alternative source for all of the blood components, and is commonly used for pre‐hospital resuscitation in severe hemorrhage 9,10 . Whole blood can be stored refrigerated for up to 35 days and is logistically easier for use in military field hospitals and battlefield trauma compared to component therapy.…”

Section: Introductionmentioning

confidence: 99%

“…8 Whole blood transfusion is an alternative source for all of the blood components, and is commonly used for pre-hospital resuscitation in severe hemorrhage. 9,10 Whole blood can be stored refrigerated for up to 35 days and is logistically easier for use in military field hospitals and battlefield trauma compared to component therapy. Our interest with this study was to determine if whole human blood exposed to high doses of radiation is still useable for transfusion in injured patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of radiation exposure and storage on the energy metabolome of platelets in whole blood

et al. 2023

View full text Add to dashboard Cite

Background Exposure to radiation through battlefield use of nuclear weapons, terrorist attacks or accidents at nuclear power plants is a current concern for the military. Beyond the risk of exposure to personnel is the intentional or accidental irradiation of our blood banking supply system. It is unknown how large doses of ionizing radiation affect storage of blood and blood products, including platelets. The major function of platelets is clot formation which includes aggregation, shape change, vesicle release, and fibrinogen attachment; these tasks require a significant amount of energy. Here, we determine whether the ionizing radiation effects the energy metabolome of platelets in storage. Study Design and Methods Fresh whole blood from healthy volunteers was subjected to 0, 25, or 75Gy of X‐irradiation, and stored at 4°C. Platelets were isolated from stored WB at 0, 1, 7, 14, and 21 days of storage. Krebs cycle intermediates, nicotinamide adenine dinucleotides, and the tri‐, di, and mono‐ phosphorylated versions of adenosine and guanosine were extracted and measured by tandem mass spectroscopy. Results Irradiation at either 25Gy or 75Gy had no significant effect on the amount of any metabolite measured compared to control (0Gy). However, there was a significant fall over time in storage for most of the metabolites measured. Discussion These data show that irradiation at high doses has no effect on the concentration of the energy metabolome of platelets derived from whole blood stored in 4°C for up to 21 days and suggests that platelets can maintain their metabolome even after radiation exposure.

show abstract

“…Traumatic shock is more prone to multiple organ dysfunction syndrome (MODS) than simple hemorrhagic shock. During its pathophysiology, ischemia-reperfusion injury induces a cascade effect of cellular signalling, leading to enhanced neuroendocrine activity; activation and release of various chemical mediators, cytokines, and oxygen radicals, which can cause a nonspecific stress response; increase vascular permeability; and lead to necrosis and disintegration of damaged tissues, further reducing circulating blood volume and aggravating tissue ischemia [ 3 , 4 ]. Patients with this disease not only have primary trauma but also multisystem functional damage, often severe blood loss, fluid loss, and symptoms of pain and anxiety [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Construction of Standard Fast Medical Procedures for Traumatic Shock and Its Application Effects

Wang

Luo

2022

Emergency Medicine International

View full text Add to dashboard Cite

Objective. To explore the construction of standard fast medical procedures for traumatic shock and its application effects. Methods. 84 patients with traumatic shock were admitted to emergency department of the hospital between January 2018 and January 2020. Using random number table method, the patients were divided into the control group (was given emergency treatment by routine emergency rescue procedures) and the study group (was given emergency treatment by standard fast medical procedures) with 42 patients in each group. The treatment time (rescue time, consultation time in each department, and examination time), shock index (SI), blood pressure fluctuation range, urine output, serum lactate (LAC) level, activated partial thromboplastin time (APTT), and international normalized ratio (INR) were recorded. The incidences of complications in the two groups within 3 days were counted. Results. The rescue time, consultation time, and examination time of the study group were shorter than those of the control group ( P < 0.05 ). After 18 h of treatment, the SI, blood pressure fluctuation range, LAC, and APTT in the study group were lower or shorter than those in the control group ( P < 0.05 ), while urine volume and INR were higher than those in the control group ( P < 0.05 ). Within 3 days of treatment, the incidence of complications in the study group was 5.41% lower than that in the control group which was 24.14% ( P < 0.05 ). Conclusion. Standard fast medical procedures can effectively shorten the time of each stage of emergency treatment for traumatic shock, which allows patients to receive effective treatment in the shortest time while improving shock symptoms and reducing related complications.

show abstract

Whole Blood for Resuscitation of Traumatic Hemorrhagic Shock in Adults

Cited by 12 publications

References 37 publications

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

Balanced resuscitation with whole blood versus component therapy in critically injured preadolescent children: Getting there faster with fewer exposures

Effects of radiation exposure and storage on the energy metabolome of platelets in whole blood

Construction of Standard Fast Medical Procedures for Traumatic Shock and Its Application Effects

Contact Info

Product

Resources

About