Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality.
Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality.
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DOI：
10.1097/xcs.0000000000000708
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发表时间：
2023-08-01
影响因子：
5.2
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中科院分区：
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低滴度O型全血（LTOWB）复苏在军事和民用环境中越来越普遍，可能代表理想的复苏干预。我们试图描述LTOWB复苏相对于血液成分复苏的安全性和有效性。在7个创伤中心进行了一项前瞻性、多中心、观察性队列研究。入组了需要输血和出血控制程序的有大量输血风险的受伤患者。主要结局为4小时死亡率。次要结局包括24小时和28天死亡率、止血效果、失血死亡和意外幸存者的发生率。共有1，051例出血性休克患者符合所有入选标准。该队列严重受伤，>70%的患者需要大量输血。倾向调整后，LTOWB和组分患者之间的4小时死亡率无显著差异（相对风险[RR] 0.90，95% CI 0.59 - 1.39，p = 0.64）。同样，对于入组队列，在24小时或28天时未证实校正的死亡率差异。当分析院前死亡概率升高的患者时，LTOWB复苏与4小时死亡风险降低48%独立相关（相对风险[RR] 0.52，95% CI 0.32至0.87，p = 0.01），28天死亡率风险降低30%（RR 0.70，95% CI 0.51至0.96，p = 0.03）。早期LTOWB复苏是安全的，但与总体入组人群的生存率无关。当根据院前损伤特征选择死亡概率较高的患者时，LTOWB与从到达后4小时至损伤后28天的死亡风险较低独立相关。本研究证实了严重创伤患者全血复苏的安全性、可行性和有效性。
Low-titer group O whole blood (LTOWB) resuscitation is becoming common in both military and civilian settings and may represent the ideal resuscitation intervention. We sought to characterize the safety and efficacy of LTOWB resuscitation relative to blood component resuscitation. A prospective, multicenter, observational cohort study was performed using 7 trauma centers. Injured patients at risk of massive transfusion who required both blood transfusion and hemorrhage control procedures were enrolled. The primary outcome was 4-hour mortality. Secondary outcomes included 24-hour and 28-day mortality, achievement of hemostasis, death from exsanguination, and the incidence of unexpected survivors. A total of 1,051 patients in hemorrhagic shock met all enrollment criteria. The cohort was severely injured with >70% of patients requiring massive transfusion. After propensity adjustment, no significant 4-hour mortality difference across LTOWB and component patients was found (relative risk [RR] 0.90, 95% CI 0.59 to 1.39, p = 0.64). Similarly, no adjusted mortality differences were demonstrated at 24 hours or 28 days for the enrolled cohort. When patients with an elevated prehospital probability of mortality were analyzed, LTOWB resuscitation was independently associated with a 48% lower risk of 4-hour mortality (relative risk [RR] 0.52, 95% CI 0.32 to 0.87, p = 0.01) and a 30% lower risk of 28-day mortality (RR 0.70, 95% CI 0.51 to 0.96, p = 0.03). Early LTOWB resuscitation is safe but not independently associated with survival for the overall enrolled population. When patients were selected with an elevated probability of mortality based on prehospital injury characteristics, LTOWB was independently associated with a lower risk of mortality starting at 4 hours after arrival through 28 days after injury. This study demonstrates the safety, feasibility, and efficacy of whole blood resuscitation in severely injured patients.