Whole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta‐analysis

Crowe, Ellen; DeSantis, Stacia M.; Bonnette, Austin; Jansen, Jan O.; Yamal, José‐Miguel; Holcomb, John B.; Pedroza, Claudia; Harvin, John A.; Marques, Marisa B.; Avritscher, Elenir B.C.; Wang, Henry E.

doi:10.1002/emp2.12089

Cited by 57 publications

(41 citation statements)

References 34 publications

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“…[24][25][26] Thus, in the setting of acute trauma care, initial plasma-directed therapy provides a superior resuscitative strategy to conventional fluids and may lessen TIC. [27][28][29] By definition, plasma is the cell-free portion of fresh whole blood that is composed of numerous components including water, proteins, carbohydrates, electrolytes, and other macromolecules. Traditionally, fresh frozen plasma (FFP) is separated from whole blood within 8 h of donation 30 and has a shelf-life of up to 1 year when stored at À18°C.…”

Section: Introductionmentioning

confidence: 99%

Ex vivo hemostatic and immuno‐inflammatory profiles of freeze‐dried plasma

et al. 2021

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Background Hemorrhage is a leading cause of preventable death in civilian and military trauma. Freeze‐dried plasma is promising for hemostatic resuscitation in remote prehospital settings, given its potential benefits in reducing blood loss and mortality, long storage at ambient temperatures, high portability, and rapid reconstitution for transfusion in austere environments. Here we assess the ex vivo characteristics of a novel Terumo's freeze‐dried plasma product (TFDP). Study design and methods Rotational thromboelastometry (ROTEM) tests (INTEM, EXTEM, and FIBTEM) were conducted on plasma samples at 37°C with a ROTEM delta‐machine using standard reagents and procedures. The following samples were analyzed: pooled plasma to produce TFDP, TFDP reconstituted, and stored immediately at −80°C, reconstituted TFDP stored at 4°C for 24 h and room temperature (RT) for 4 h before freezing at −80°C. Analysis of plasma concentrations of selected cytokines, chemokines, and vascular molecules was performed using a multiplex immunoassay system. One‐way ANOVA with post hoc tests assessed differences in hemostatic and inflammatory properties. Results No significant differences in ROTEM variables (coagulation time [CT], clot formation time, α‐angle, maximum clot firmness, and lysis index 30) between the TFDP‐producing plasma and reconstituted TFDP samples were observed. Compared to control plasma, reconstituted TFDP stored at 4°C for 24 h or RT for 4 h showed a longer INTEM CT. Levels of immuno‐inflammatory mediators were similar between frozen plasma and TFDP. Conclusions TFDP is equivalent to frozen plasma with respect to global hemostatic and immuno‐inflammatory mediator profiles. Further investigations of TFDP in trauma‐induced coagulopathy models and bleeding patients are warranted.

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Section: Introductionmentioning

confidence: 99%

Ex vivo hemostatic and immuno‐inflammatory profiles of freeze‐dried plasma

et al. 2021

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“…Importantly, this study highlighted the heterogeneity in the literature on WB transfusion in trauma. No study in this analysis was from the civilian setting in a LMIC 25 .…”

Section: Discussionmentioning

confidence: 99%

Is the Whole Greater than the Sum of Its Parts? The Implementation and Outcomes of a Whole Blood Program in Ecuador

Himmler

Armijos

Naranjo

et al. 2021

Preprint

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Background: Hemorrhagic shock is a major cause of mortality in low-and-middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood program in Latin America and to discuss the outcomes of the patients that received whole blood (WB).Methods: We conducted a retrospective review of patients resuscitated with WB from 2013-2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included: gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, Shock Index, Revised Trauma Score (RTS) in trauma patients, intraoperative crystalloid (lactated ringers or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length-of-stay and in-hospital mortality.Results: The sample includes a total of 101 patients, 57 of whom were trauma and acute care surgery (TACS) patients and 44 of whom were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. Average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of whole blood. Overall mortality was 14/101 (13.86%) in the first 24 hours and 6/101 (5.94%) after 24 hours.Conclusion: Implementing a WB protocol is achievable in LMICs. Whole blood allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a whole blood program implemented in a civilian hospital in Latin America.

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“…In contrast, three other observational, single‐center studies with median WB doses of 2, 6.5, and 2 units did not show a decrease in mortality 13‐15 . Finally, a meta‐analysis of studies that measured 24‐h and 30‐day in‐hospital survival failed to demonstrate a survival advantage to patients treated with WB compared with CT 17 …”

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confidence: 84%