Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma
Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma
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DOI：
10.1097/ta.0000000000002753
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发表时间：
2020-08-01
影响因子：
3.4
通讯作者：
Joseph, Bellal
中科院分区：
文献类型：
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作者：
Hanna, Kamil;Bible, Letitia;Joseph, Bellal
导言在全血(WB)用于军事用途后，平民对全血复苏重新产生了兴趣。关于它在平民中的作用的数据很少，在那里平衡成分疗法(CT)复苏是护理的标准。本研究的目的是评估在全国范围内使用WB作为辅助CT和单独使用CT复苏平民创伤患者的结果。方法我们分析了(2015-2016)创伤质量改进计划。我们纳入了成年(年龄=18岁)创伤患者，他们表现为失血性休克，需要在4小时内至少输注1U的红细胞。患者被分成WB-CT和CT两组。主要结果是24小时内和住院期间死亡率。次要结果是住院时间和主要并发症。结果共鉴定出8494例患者，其中280例接受WB-CT检查(WB，1[1-1]；pRBC，16[10-23]；FFP，9[6-16]；血小板，3[2-5])；8214例接受CT检查(pRBC，15[10-24]；FFP，10[6-16]；血小板，2[1-4])。SD患者平均年龄34~16岁，其中79%为男性，损伤严重程度评分为33分(24~43分)，63%有穿透性损伤。接受WB-CT的患者有较低的24小时死亡率(17%比25%；p=0.002)、住院死亡率(29%比40%；p<；0.001)、主要并发症(29%比41%；p<；0.001)和较短的住院时间(9[7-12]比15[10-21]；p=0.011)。回归分析显示，WB与24小时死亡率(OR0.78[0.59-0.89]；p=0.006)、住院死亡率(OR0.88[0.81-0.90]；p=0.011)和主要并发症(OR0.92[0.87-0.96]；p=0.013)独立相关。需要进一步的研究来评估在大量输血方案中加入白蛋白的作用。证据治疗水平，IV级。
INTRODUCTION Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.METHODS We analyzed the (2015-2016) Trauma Quality Improvement Program. We included adult (age, >= 18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.RESULTS A total of 8,494 patients were identified, of which 280 received WB-CT (WB, 1 [1-1]; pRBC, 16 [10-23]; FFP, 9 [6-16]; platelets, 3 [2-5]) and 8,214 received CT only (pRBC, 15 [10-24]; FFP, 10 [6-16]; platelets, 2 [1-4]). Mean SD age was 34 16 years, 79% were male, Injury Severity Score was 33 (24-43), and 63% had penetrating injuries. Patients who received WB-CT had a lower 24-hour mortality (17% vs. 25%; p = 0.002), in-hospital mortality (29% vs. 40%; p < 0.001), major complications (29% vs. 41%; p < 0.001), and a shorter length of stay (9 [7-12] vs. 15 [10-21]; p = 0.011). On regression analysis, WB was independently associated with reduced 24-hour mortality (odds ratio [OR], 0.78 [0.59-0.89]; p = 0.006), in-hospital mortality (OR, 0.88 [0.81-0.90]; p = 0.011), and major complications (OR, 0.92 [0.87-0.96]; p = 0.013).CONCLUSION The use of WB as an adjunct to CT is associated with improved outcomes in resuscitation of severely injured civilian trauma patients. Further studies are required to evaluate the role of adding WB to massive transfusion protocols.LEVEL OF EVIDENCE Therapeutic, level IV.