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Should We Use Whole Blood for Trauma Patients?

February 13, 2024

Written by Amanda Mathews

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Trauma patients who were resuscitated with whole blood compared to component therapy had improved 24-hour mortality and a decrease in the total amount of blood products needed for resuscitation.

Parts…or the whole?
This was a single-center prospective observational study that used a combination of retrospective and prospective data collection. Patients were included if they were >18 years old and had a massive transfusion protocol (MTP) activation due to trauma. 348 patients were included in the study, with 180 patients receiving resuscitation with component therapy (CT) and 168 receiving low titer group O whole blood (LTOWB). Component therapy is the 1:1:1 (pRBC: plasma: platelet) resuscitation strategy commonly used in emergency departments and hospitals. The primary objective was to compare 24-hour mortality between the populations, with secondary objectives of comparing organ injury and total amount of blood products infused within the first 72 hours of admission.

Researchers found a statistically significant improvement in mortality at 24 hours for the LTOWB group (8% vs 19%, p=0.03), but the difference was not significant at 28 days. Patients who received LTOWB had a 40% reduction in total weight-normalized blood product used over the first 72 hours of admission. The equated to approximately 30 mL/kg less, which in an 80kg patient is a 2.4L reduction in blood product volume. There was no significant difference in adverse events among the two groups.

Researchers also collected rotational thromboelastometry (ROTEM) samples on all patients. They found that the trend of improved mortality was conserved when looking at patients with a high PTT (>26 s) and a low maximum clot firmness (MCF, <60) leading them to hypothesize that LTOWB may be particularly beneficial in hypocoagulable patients. 

How will this change my practice?
My institution is starting a trial using LTOWB in the resuscitation of trauma patients with hemorrhagic shock, and more institutions are using whole blood. This study shows evidence of improved short-term mortality but, even more striking, a significant decrease in the amount of product transfused over 72 hours in the hospital. With continued national blood shortages, this could be particularly important to conserve blood products.

Doing more with less: low-titer group O whole blood resulted in less total transfusions and an independent association with survival in adults with severe traumatic hemorrhage. J Thromb Haemost. 2024 Jan;22(1):140-151. doi: 10.1016/j.jtha.2023.09.025. Epub 2023 Oct 4.