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While blood component transfusions have been the standard of care for the past four decades, there is increasing interest in whole blood for hemorrhaging trauma patients. To help determine if whole blood, as an adjunct to component-based transfusions, is associated with improved survival over standard massive-transfusion protocols, researchers retrospectively compared two cohorts of adult trauma patients from the American College of Surgeons Trauma Quality Improvement Program database. The researchers examined data from 2785 civilian trauma patients (systolic blood pressure <90mm Hg, shock index >1, and median severity injury score, 28) who received at least 4 units of RBCs within the first hour at the emergency room during 2017 and 2018. Of these, 432 (78% male; median age, 38 years) received at least one unit of whole blood in addition to standard massive transfusion care; 2353 (77% male; median age, 38 years) received standard care. Whole blood transfusion was associated with a 37% lower risk of mortality compared to standard care (HR, 0.63; 95% C.I., 0.41 to 0.96; p=0.03), and this lower mortality remained consistent at 30 days. Further studies are needed to refine the care of those patients with massive hemorrhaging from trauma.
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