Equivalent and resource-saving: Whole blood versus component therapy for trauma resuscitation

Use of low-titer O+ whole blood (LTOWB) in civilian trauma has increased in recent years. This project evaluated multiple patient-centered and resource-related outcomes related to the initiation of our facility's LTOWB program in November 2020.

This retrospective cohort study examined patients receiving component therapy versus LTOWB within 4 h of arrival to our trauma center in November 2018 to 2022. Females were excluded due to ineligibility. After 1:1 matching, double-robust estimation was used to model outcomes.

A total of 218 patients were included. LTOWB was associated with equivalent or better outcomes for all variables assessed. Overall mortality was similar between groups (hazard ratio = 1.05, 95% CI = 0.65-1.68). Emergency department mortality was lower in patients receiving LTOWB (12.7% vs. 20.9%, p = 0.006). Among survivors, lengths of stay were non-significantly shorter with LTOWB (13 ± 14 days vs. 17 ± 29 days, p = 0.096). Among non-survivors, patients who received LTOWB survived longer before succumbing (1.3 ± 3.1 days vs. 0.2 ± 0.6 days, p = 0.012). Total massive transfusion volumes, including LTOWB, were 40% lower with LTOWB (rate ratio = 0.60, 95% CI = 0.43-0.85).

This evaluation of our LTOWB program indicates many outcomes are similar with LTOWB and component therapy. However, LTOWB patients survived longer during initial resuscitation and had lower massive transfusion requirements. This represents an opportunity to conserve blood products and provides opportunities for surgical rescue in severely injured patients.