2020 Trauma/Critical Care Presentations

Phillip Kemp Bohan, MD, Robert C Chick, MD, Jason Forcum, RN, Remealle A How, MD, Valerie G Sams, MD; Brooke Army Medical Center

Objectives: Military experience demonstrates low-titer O whole blood (LTOWB) to be beneficial for trauma patients in hemorrhagic shock. However, few civilian centers have implemented LTOWB for trauma resuscitation. Here, we evaluate the early experience and safety of a LTOWB program at a Level 1 trauma center.

Methods: The prospectively maintained trauma database of a Level 1 trauma center was retrospectively queried for patients admitted between January 2018-August 2019 with evidence of shock (heart rate [HR] >120, systolic blood pressure [SBP] <90mmHg, or shock index [SI; HR/SBP] >0.9) who received blood products prior to or within 24 hours (h) of arrival. Patients who received prehospital LTOWB were excluded. Patients were divided into 3 recipient groups: LTOWB only (Group 1), component therapy (CT) only (Group 2), and LTOWB+CT (Group 3). Demographics, injury severity score (ISS), trauma injury severity score (TRISS), abbreviated injury scale (AIS), amount of product received, safety, and outcomes (24h, 30-day [d], and overall mortality, ICU length of stay [LOS], and hospital LOS) were evaluated. Statistical significance was set at p<0.05. Regression analysis was performed to identify variables predictive of mortality.

Results: 147 patients were included: 12 in Group 1, 99 in Group 2, and 36 in Group 3. Compared to Groups 1 and 2, Group 3 patients were more frequently male (p=0.024), had higher ISS (28 vs 20 and 17, respectively; p=0.003), and had lower TRISS (0.79 versus 0.96 and 0.95, respectively; p=0.006). Group 3 received the most LTOWB (median 4u), PRBCs (2u), and FFP (2u) at 24h compared to Groups 1 and 2 (p<0.001 for each). There was no statistical difference in 24h mortality between Groups 1, 2, and 3 (16.7%, 19.2%, and 33.3%, respectively), though Group 3 had higher 30d mortality (44.4% vs 16.7% and 24.2%, respectively; p=0.045). There were no differences between groups in rates of pulmonary embolism, deep vein thrombosis, unplanned ICU transfer, unplanned intubation, and ICU or hospital LOS. On regression analysis, the only variable to meet significance was TRISS (p<0.01) for 24h, 30d, and overall mortality.

Conclusions: The most severely injured trauma patients received combination LTOWB+CT and more overall product units. Despite being more severely injured, patients who received LTOWB+CT had similar 24h mortality as LTOWB or CT alone. No increase in transfusion-related complications was seen in any group receiving LTOWB. LTOWB is not inferior to CT and is a safe and feasible means of resuscitation of hemorrhaging trauma patients in civilian centers.