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Whole blood resuscitation and post-traumatic organ dysfunction in injured children
Erin V Feeney1, Madelyn A Scarmack2, Leah M Furman1
1Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Early whole blood (WB) transfusion in pediatric trauma patients may reduce organ dysfunction compared to component therapy (CT). Further research is needed to confirm the clinical benefits of WB resuscitation.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Resuscitation
- Blood Transfusion Therapy
Background:
- Whole blood (WB) and component therapy (CT) are used for hemostatic resuscitation in pediatric trauma.
- The comparative effectiveness of early WB versus CT in reducing post-traumatic organ dysfunction is unclear.
Purpose of the Study:
- To investigate the association between early whole blood transfusion and post-traumatic organ dysfunction in children.
- To compare the outcomes of WB resuscitation versus CT alone in injured pediatric patients.
Main Methods:
- Single-center observational study of children (0-17 years) with trauma and ICU admission.
- Primary outcome: Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score (days 1-7).
- Linear regression analysis adjusted for covariates including injury severity and transfusion volume.
Main Results:
- Of 540 subjects, 52 received transfusion within 4 hours.
- Transfusion of WB plus other products was associated with lower PELOD-2 scores compared to RBC plus other products.
- WB alone or RBC alone groups were smaller and not directly compared in adjusted analysis.
Conclusions:
- Receipt of any whole blood (WB) versus component therapy (CT) alone for hemostatic resuscitation was associated with reduced organ dysfunction in transfused pediatric trauma patients.
- Further large-scale studies are required to confirm clinical benefits and understand mechanisms.
Background:
Both whole blood (WB) and component therapy (CT) are used for hemostatic resuscitation in injured children. We hypothesize that early WB transfusion compared to CT alone is associated with decreased post-traumatic organ dysfunction.
Study Design And Methods:
This single-center observational study included children ages 0-17 years between January 2021 and March 2024 with trauma mechanism and intensive care unit admission. The primary outcome was Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score on post-trauma days 1-7. Data were analyzed using linear regression adjusting for age, sex, race, year, injury mechanism, injury severity score (ISS), shock index pediatric age-adjusted, and total 4-h transfusion volume (mL/kg).
Results:
In total, 540 subjects met eligibility criteria; of the 52/540 (10%) who received blood transfusion within 4 h, 11/52 (21%) received RBC alone, 12/52 (23%) received WB alone, 9/52 (17%) of subjects received RBC plus other, and 20/52 (38%) received WB plus other. The cohort was 60% (326/540) male, 83% (449/540) blunt injury mechanism, median (interquartile range [IQR]) age 3 years (0-11), and median (IQR) ISS of 11 (8-18). In adjusted analysis, transfusion of WB + other was an independent predictor of lower PELOD-2 score through post-trauma day 7 in comparison to subjects receiving RBC + other.
Discussion:
In subjects who were transfused multiple blood products, receipt of any WB versus CT alone for hemostatic resuscitation after injury was associated with reduced organ dysfunction. Further investigation is needed in large cohorts to fully elucidate clinical benefit and improve mechanistic understanding.
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