Cold-Stored Whole Blood: A Better Method of Trauma Resuscitation?
INTRODUCTION: Cold-stored whole blood (CWB) provides a balance of red blood cells, plasma, and platelets in less anticoagulant volume than standard blood component therapy (BCT). We hypothesize that patients receiving CWB along with BCT have improved survival compared to patients receiving only BCT.
METHODS: We performed a dual-center case-match study of trauma patients who received CWB and BCT at two urban, Level-I Trauma Centers. Criteria to receive CWB included male age ≥16, female age >50, SBP<90 >mmHg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received ≥1u of packed red cells (PRBCs) during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test. P
RESULTS: Between both institutions, a total of 107 patients received CWB during the study period with 91 being matched to 182 BCT patients for analysis. Hemodynamic parameters of the patients in both groups at the time of presentation were similar. CWB patients had higher mean hemoglobin (10±2 g/dL vs 11±2 g/dL;p
CONCLUSION: CWB offers the benefit of a balanced resuscitation with improved trauma bay survival and higher mean hemoglobin at 24 hours. A larger, prospective study is needed to determine whether it has a longer-term survival benefit for severely injured patients.
LEVEL OF EVIDENCE: III STUDY TYPE:: Therapeutic.
Published In/Presented At
Hazelton, J. P., Cannon, J. W., Zatorski, C. M., Roman, J. S., Moore, S. A., Young, A. J., Subramanian, M. Guzman, J. Fogt, F. Moran, A. Gaughan, J. Seamon. M. J., Porter, J. (2019). Cold-Stored Whole Blood: A Better Method of Trauma Resuscitation?. Journal of Trauma Acute Care Surgery.
Department of Surgery, Department of Surgery Residents