whole blood transfusion
There is an ever-growing body of evidence to suggest that whole-blood transfusion should be the way to go in adult trauma resuscitation. But what about the kids? This large retrospective study evaluated 4-hour and 24-hour mortality in children under 18 receiving transfusion within the first 4 hours after presenting for blunt or penetrating trauma to one of 456 US trauma centers. They wanted to see how the kids did when they received whole blood vs when the received component therapy (pRBCs + platelets + FFP in whatever ratio was decided by the treating team).
They included 4,323 patients, the vast majority of which received component therapy only (88%). The remaining 12% received either whole blood alone or whole blood + component therapy. The whole blood group (alone or in combo) were older, sicker (more likely to be in shock and had higher injury severity scores), more likely to be male and had more penetrating injuries.
Initial, unadjusted mortality showed no significant difference, but after adjusting for potential confounders, the authors found that whole blood transfusion was significantly associated with a lower adjusted odds of 4-hour (aOR 0.58) and 24-hour (aOR 0.46) mortality. This is for receiving ANY volume of whole blood transfusion (alone or in combo with component therapy). Additionally, for every 10% increase in whole blood (relative to total transfusion volume), there was a 9% decrease in mortality at 24 hours. Given that the whole blood group was the sicker group in the first place, this much mortality benefit is impressive.
Bottom line: When available to you, consider using whole-blood as your first choice in transfusion of the traumatically injured child.
They included 4,323 patients, the vast majority of which received component therapy only (88%). The remaining 12% received either whole blood alone or whole blood + component therapy. The whole blood group (alone or in combo) were older, sicker (more likely to be in shock and had higher injury severity scores), more likely to be male and had more penetrating injuries.
Initial, unadjusted mortality showed no significant difference, but after adjusting for potential confounders, the authors found that whole blood transfusion was significantly associated with a lower adjusted odds of 4-hour (aOR 0.58) and 24-hour (aOR 0.46) mortality. This is for receiving ANY volume of whole blood transfusion (alone or in combo with component therapy). Additionally, for every 10% increase in whole blood (relative to total transfusion volume), there was a 9% decrease in mortality at 24 hours. Given that the whole blood group was the sicker group in the first place, this much mortality benefit is impressive.
Bottom line: When available to you, consider using whole-blood as your first choice in transfusion of the traumatically injured child.
