Cold-stored whole blood: A better method of trauma resuscitation?

Joshua Paul Hazelton, Jeremy W. Cannon, Catherine Zatorski, Janika San Roman, Sarah A. Moore, Andrew J. Young, Madhu Subramanian, Jessica F. Guzman, Franz Fogt, Anna Moran, John Gaughan, Mark J. Seamon, John Porter

Research output: Contribution to journalArticle

Abstract

BACKGROUND: 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 with 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 boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 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. The 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% vs. 2.2%;p = 0.039). Thirty-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 periods. CONCLUSION: Cold-stored whole blood 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: Therapeutic, level III.

Original languageEnglish (US)
Pages (from-to)1035-1041
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume87
Issue number5
DOIs
StatePublished - Nov 1 2019

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Resuscitation
Wounds and Injuries
Mortality
Survival
Hemoglobins
Therapeutics
Trauma Centers
Blood Volume
Hematocrit
Anticoagulants
Blood Platelets
Erythrocytes
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Hazelton, J. P., Cannon, J. W., Zatorski, C., Roman, J. S., Moore, S. A., Young, A. J., ... Porter, J. (2019). Cold-stored whole blood: A better method of trauma resuscitation? Journal of Trauma and Acute Care Surgery, 87(5), 1035-1041. https://doi.org/10.1097/TA.0000000000002471
Hazelton, Joshua Paul ; Cannon, Jeremy W. ; Zatorski, Catherine ; Roman, Janika San ; Moore, Sarah A. ; Young, Andrew J. ; Subramanian, Madhu ; Guzman, Jessica F. ; Fogt, Franz ; Moran, Anna ; Gaughan, John ; Seamon, Mark J. ; Porter, John. / Cold-stored whole blood : A better method of trauma resuscitation?. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 87, No. 5. pp. 1035-1041.
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abstract = "BACKGROUND: 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 with 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 boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 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. The 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{\%} vs. 2.2{\%};p = 0.039). Thirty-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 periods. CONCLUSION: Cold-stored whole blood 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: Therapeutic, level III.",
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Hazelton, JP, Cannon, JW, Zatorski, C, Roman, JS, Moore, SA, Young, AJ, Subramanian, M, Guzman, JF, Fogt, F, Moran, A, Gaughan, J, Seamon, MJ & Porter, J 2019, 'Cold-stored whole blood: A better method of trauma resuscitation?', Journal of Trauma and Acute Care Surgery, vol. 87, no. 5, pp. 1035-1041. https://doi.org/10.1097/TA.0000000000002471

Cold-stored whole blood : A better method of trauma resuscitation? / Hazelton, Joshua Paul; Cannon, Jeremy W.; Zatorski, Catherine; Roman, Janika San; Moore, Sarah A.; Young, Andrew J.; Subramanian, Madhu; Guzman, Jessica F.; Fogt, Franz; Moran, Anna; Gaughan, John; Seamon, Mark J.; Porter, John.

In: Journal of Trauma and Acute Care Surgery, Vol. 87, No. 5, 01.11.2019, p. 1035-1041.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cold-stored whole blood

T2 - A better method of trauma resuscitation?

AU - Hazelton, Joshua Paul

AU - Cannon, Jeremy W.

AU - Zatorski, Catherine

AU - Roman, Janika San

AU - Moore, Sarah A.

AU - Young, Andrew J.

AU - Subramanian, Madhu

AU - Guzman, Jessica F.

AU - Fogt, Franz

AU - Moran, Anna

AU - Gaughan, John

AU - Seamon, Mark J.

AU - Porter, John

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: 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 with 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 boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 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. The 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% vs. 2.2%;p = 0.039). Thirty-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 periods. CONCLUSION: Cold-stored whole blood 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: Therapeutic, level III.

AB - BACKGROUND: 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 with 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 boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 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. The 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% vs. 2.2%;p = 0.039). Thirty-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 periods. CONCLUSION: Cold-stored whole blood 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: Therapeutic, level III.

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