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Year:: 2023
Contributor:: Feinberg, Griffin (Author); Tillman, Anastasia (Author); Paiva, Marcelo (Author); Emigh, Brent (Author); Lueckel, Stephanie (Author); Hynes, Allyson (Author); Kheirbek, Tareq (Author); Brown University. Alpert Medical School. Scholarly Concentration Program. Non-Scholarly Concentrator (research program)
Subject:: Blood--Transfusion; trauma

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Abstract:: Introduction: Whole blood (WB) transfusion has been shown to improve mortality in trauma resuscitation. Optimal ratio of packed red blood cells (PRBC) to WB in emergent transfusion has not been determined. We hypothesized maintaining a low ratio is associated with improved survival. Methods: We analyzed the 2021 Trauma Quality Improvement Program (TQIP) database to identify patients who underwent hemorrhage control surgery and were transfused within four hours of hospital arrival, excluding outside facility transfers or emergency department deaths. We stratified patients based on PRBC:WB ratios. The primary outcome was mortality at 24 hours. Logistic regression was performed to estimate odds of mortality among ratio groups compared to WB alone, adjusting for injury severity, time to intervention, and demographics. Significance was set at α=0.05. Results: Our cohort included 17,562 patients; of those, 13,678 patients had PRBC only. FFP:PRBC ratio was balanced in all groups. Among those who received WB (n=3,884), there was a significant increase in 24-hour mortality with higher PRBC:WB ratios (WB alone 5.2%, 1:1 10.9%, 2:1 11.8%, 3:1 14.9%, 4:1 20.9%, 5:1 34.1%, p=0.0001). For patients who received PRBC only, 24hr mortality was 12.8% (p=0.0001 compared to 4:1 and 5:1 ratio groups). We identified a 3:1 ratio as an optimal cut point. Adjusted odds ratios of 24-hour mortality for 4:1 and 5:1 groups were 2.85 (95%CI: 1.19 – 6.81) and 2.89 (95% CI: 1.29 – 6.49). Conclusion: Our analysis shows that increasing PRBC:WB ratio diminished survival benefits of WB in trauma resuscitation. Further efforts should emphasize this relationship to optimize trauma resuscitation protocols.
Notes:: Scholarly concentration: Non-Scholarly Concentrator

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Feinberg, Griffin, Tillman, Anastasia, Paiva, Marcelo, et al., "A Drop in the Ocean: Does Whole Blood Dilution Effect Outcomes in Hemorrhagic Resuscitation?" (2023). Warren Alpert Medical School Academic Symposium. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:5whsm25x/

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Warren Alpert Medical School Academic Symposium

The Warren Alpert Medical School Academic Symposium is an annual event at Warren Alpert Medical School of Brown University that provides Year II medical students a venue to present their summer research in a poster format. Participation in the Symposium …
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A Drop in the Ocean: Does Whole Blood Dilution Effect Outcomes in Hemorrhagic Resuscitation?