Characterizing the Use of Autologous Blood Transfusions for Resuscitation after Trauma: A Trauma Quality Improvement...

Background: Hemorrhage is a leading cause of death in trauma, and whole blood transfusions has better outcomes compared to component transfusions. Autologous whole blood transfusion has less risk of immune-mediated reactions and may reduce total volume of allogenic transfusions. Additionally, autologous transfusion may offer prompt volume resuscitation in resource-limited areas such as the deployed environment. Despite these potential benefits, data are limited on the use of autologous blood transfusion in trauma. We sought to evaluate the utilization of autologous blood transfusion within the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP). Materials and Methods: We analyzed the 2017-2023 TQIP datasets for cases involving autologous blood product transfusions within 24 hours of hospital admission. Using facility keys, we identified the number of facilities performing this procedure and conducted a descriptive statistical analysis. Results: There were 5,608 encounters that met inclusion for this analysis. The median age was 40 (IQR 27-62) and 76% were male. Blunt trauma secondary to collisions accounted for the largest proportion at 46%. The median composite injury severity score was 22 (13-30). The most commonly injured body regions were the thorax (61%) followed by the abdomen (52%) and the extremities (52%). Most were alive at 24 hours (73%) and discharged (72%). The most commonly administered blood products were red blood cells (68%) and plasma (48%). There were 304 (6%) that were <18 years of age. The yearly percentage of facilities with documented use generally remained steady from 18-24% with 73% performed at designated level 1 centers. The maximum number reported at a single facility on a yearly basis generally remained steady from 106-179 encounters. Conclusion: Autologous blood transfusions within the first 4 hours were uncommon, but the largest proportion occurred at verified level 1 trauma centers. Better data are needed to understand this practice pattern and outcomes.