Doing more with less: low-titer group O whole blood resulted in less total transfusions and an independent association with survival in adults with severe traumatic hemorrhage

Susan M. Shea, Emily P. Mihalko, Liling Lu, Kimberly A. Thomas, Douglas Schuerer, Joshua B. Brown, Grant V. Bochicchio, Philip C. Spinella

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Low-titer group O whole blood (LTOWB) or component therapy (CT) may be used to resuscitate hemorrhaging trauma patients. LTOWB may have clinical and logistical benefits and may improve survival. Objectives: We hypothesized LTOWB would improve 24-hour survival in hemorrhaging patients and would be safe and equally efficacious in non–group O compared with group O patients. Methods: Adult trauma patients with massive transfusion protocol activations were enrolled in this observational study. The primary outcome was 24-hour mortality. Secondary outcomes included 72-hour total blood product use. A Cox regression determined the independent associations with 24-hour mortality. Results: In total, 348 patients were included (CT, n = 180; LTOWB, n = 168). Demographics were similar between cohorts. Unadjusted 24-hour mortality was reduced in LTOWB vs CT: 8% vs 19% (P = .003), but 6-hour and 28-day mortality were similar. In an adjusted analysis with multivariable Cox regression, LTOWB was independently associated with reduced 24-hour mortality (hazard ratio, 0.21; 95% CI, 0.07-0.67; P = .004). LTOWB patients received significantly less 72-hour total blood products (80.9 [41.6-139.3] mL/kg vs 48.9 [25.9-106.9] mL/kg; P < .001). In stratified 24-hour survival analyses, LTOWB was associated with improved survival for patients in shock or with coagulopathy. LTOWB use in non–group O patients was not associated with increased mortality, organ injury, or adverse events. Conclusion: In this hypothesis-generating study, LTOWB use was independently associated with improved 24-hour survival, predominantly in patients with shock or coagulopathy. LTOWB also resulted in a 40% reduction in blood product use which equates to a median 2.4 L reduction in transfused products.

Original languageEnglish
Pages (from-to)140-151
Number of pages12
JournalJournal of Thrombosis and Haemostasis
Volume22
Issue number1
DOIs
StatePublished - Jan 2024

Keywords

  • blood transfusion
  • hemorrhage
  • mortality
  • resuscitation
  • trauma

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