Cold-stored versus room-temperature platelets for hemostasis in combat trauma patients

Area of Science:

• Military Medicine
• Transfusion Medicine
• Trauma Care

Background:

• Room temperature platelets (RTPs) have been used in combat since 2004, but their distribution is limited.
• Cold-stored platelets (CSPs) were approved for extended storage (10-14 days) to improve access in remote locations.
• Clinical outcomes for CSP use in combat trauma have been sparsely reported.

Purpose of the Study:

• To assess the association between cold-stored platelets (CSPs) and mortality in combat trauma patients.
• To compare the clinical outcomes of CSP transfusions with room temperature platelets (RTPs).

Main Methods:

• Retrospective analysis of military combat casualty records from 2001-2023.
• Compared mortality at discharge between patients receiving CSPs (10- or 14-day storage) and a control group receiving only RTPs.
• Logistic regression analysis was used to compare treatment groups.

Main Results:

• 124 patients receiving CSPs were analyzed; overall mortality was 16.1% in the CSP group and 13.9% in the RTP control group.
• Transfusion of 10-day CSPs (adjOR=0.39) or 14-day CSPs (adjOR=0.41) was associated with significantly decreased mortality.
• The outdating rate for CSPs was 93.4%, compared to 75.2% for RTPs.

Conclusions:

• Cold-stored platelets (CSPs) up to 14 days appear non-inferior to short-shelf-life RTPs.
• CSP use, particularly towards the end of their shelf life, indicates fulfillment of previously unmet transfusion needs.
• CSPs facilitate timely platelet transfusions in remote settings, improving patient outcomes and warranting further evaluation for broader emergent use.