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J Trauma Acute Care Surg. 2019 Aug 5. doi: 10.1097/TA.0000000000002471. [Epub ahead of print]

Cold-Stored Whole Blood: A Better Method of Trauma Resuscitation?

Author information

1
Division of Trauma, Acute Care & Critical Care Surgery, Penn State College of Medicine, Hershey, PA, (jhazelton@pennstatehealth.psu.edu).
2
Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
3
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, (jeremy.cannon@pennmedicine.upenn.edu).
4
Department of Surgery, Lehigh Valley Health Network, Allentown, PA. (catherinezatorski@gmail.com).
5
Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, NJ. (sanroman-janika@cooperhealth.edu).
6
Department of Surgery, University of New Mexico, Albuquerque, NM. (smoore@salud.unm.edu).
7
Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. (andrew.young@pennmedicine.upenn.edu).
8
Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (madhu.subramanian@uphs.upenn.edu).
9
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (jessica.guzman2@pennmedicine.upenn.edu).
10
Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. (anna.moran@pennmedicine.upenn.edu).
11
Department of Medicine, Cooper University Hospital, Camden, NJ. (gaughan-john@cooperhealth.edu).
12
Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. (mark.seamon@pennmedicine.upenn.edu).
13
Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, NJ. (porter-john@cooperhealth.edu).

Abstract

INTRODUCTION:

Cold-stored whole blood (CWB) provides a balance of red blood cells, plasma, and platelets in less anticoagulant volume than standard blood component therapy (BCT). We hypothesize that patients receiving CWB along with BCT have improved survival compared to patients receiving only BCT.

METHODS:

We performed a dual-center case-match study of trauma patients who received CWB and BCT at two urban, Level-I Trauma Centers. Criteria to receive CWB included male age ≥16, female age >50, SBP<90 mmHg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received ≥1u of packed red cells (PRBCs) during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test. P<0.05 was significant.

RESULTS:

Between both institutions, a total of 107 patients received CWB during the study period with 91 being matched to 182 BCT patients for analysis. Hemodynamic parameters of the patients in both groups at the time of presentation were similar. CWB patients had higher mean hemoglobin (10±2 g/dL vs 11±2 g/dL;p<0.001) and hematocrit (29.2±6.1% vs 32.1±5.8%;p<0.001) at 24 hours. Importantly, trauma bay mortality was less in CWB patients (8.8% v. 2.2%;p=0.039). 30-day mortality was not different in CWB patients and there were no differences in the total amount of blood products transfused at the 4-hour and 24-hour time periods.

CONCLUSION:

CWB offers the benefit of a balanced resuscitation with improved trauma bay survival and higher mean hemoglobin at 24 hours. A larger, prospective study is needed to determine whether it has a longer-term survival benefit for severely injured patients.

LEVEL OF EVIDENCE:

III STUDY TYPE:: Therapeutic.

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