The balance of transfused blood components for trauma patients has been investigated with an emphasis on including whole blood (WB) to supplement massive transfusion protocols. One recent study found a 37% and 47% lowered risk of mortality at 24 hours and 30 days, respectively, for trauma patients transfused with WB. Only 24% of American College of Surgeons-verified trauma centers, however, use WB. How the timing of WB transfusions affects survival of trauma patients is unclear and may be inhibiting WB use for trauma patients. To gain a better understanding of when WB should be administered to trauma patients, researchers retrospectively analyzed data from 1394 adult trauma patients (83% male; median age, 39 years; median injury severity score, 27) at level 1 and 2 trauma centers in the U.S. and Canada during 2019 and 2020 who received WB in addition to the massive transfusion protocol. Based on multivariable survival hazards regression models (which take into account time-dependent effects), WB given earlier improved survival at both 24 hours and 30 days compared to later time points (adjusted hazard ratio, 0.40; 95% C.I., 0.22 to 0.73, p=0.003 for 24 hours and aHR, 0.32; 95% C.I., 0.22 to 0.45; p<0.001 for 30 days). The most profound reduction in survival was found when the time to WB transfusion took longer than 14 minutes. Further prospective studies are needed on when blood products should be administered to trauma patients.
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