Data-Driven Blood Transfusion Thresholds for Severely Injured Patients During Blood Shortages

Area of Science:

• Trauma Surgery
• Transfusion Medicine
• Healthcare Management

Background:

• Blood product shortages, exacerbated by events like the COVID-19 pandemic, pose significant risks to patients requiring transfusions.
• Institutions may need to implement judicious blood administration strategies during massive blood transfusions protocols (MTP) under scarcity conditions.

Purpose of the Study:

• To provide data-driven guidance for modifying MTP during severe blood supply limitations.
• To establish evidence-based MTP volume thresholds based on age and risk factors.

Main Methods:

• Retrospective cohort study of 47 trauma centers (TC) using a unified MTP protocol (2017-2019).
• Analysis of mortality as a function of blood transfusion volume and patient age.
• Estimation of hemoglobin thresholds and futility measures.
• Risk-adjusted analyses using multivariable and hierarchical regression.

Main Results:

• Proposed MTP maximum volume thresholds: 60 units (16-30 y), 48 units (31-55 y), 24 units (>55 y).
• Mortality ranged from 30%-36% below thresholds, doubling to 67-77% when exceeded.
• Prehospital cardiac arrest and nonreactive pupils were indicators of futility; in-hospital factors included midline shift on brain CT and cardiopulmonary arrest.

Conclusions:

• Establishing age-based MTP thresholds can sustain blood availability during shortages.
• Key risk factors should be considered in MTP modification under limited blood supply conditions.