Prehospital low titer group O whole blood is feasible and safe: Results of a prospective randomized pilot trial. Issue 5 (25th May 2022)

• Record Type: Journal Article
• Authors: Guyette, Frank X.; Zenati, Mazen; Triulzi, Darrell J.; Yazer, Mark H.; Skroczky, Hunter; Early, Barbara J.; Adams, Peter W.; Brown, Joshua B.; Alarcon, Louis; Neal, Matthew D.; Forsythe, Raquel M.; Zuckerbraun, Brian S.; Peitzman, Andrew B.; Billiar, Timothy R.; Sperry, Jason L.
• Is Part Of: Journal of trauma and acute care surgery. Volume 92:Issue 5(2022)
• Page Start: 839
• Page End: 847
• Publication Date: 2022-05-25
• Subjects: Low titer type O whole blood -- randomized -- pilot trial; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003551
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : Prehospital through in-hospital LTOWB resuscitation is safe and may be associated with hemostatic benefits. A large-scale clinical trial is feasible with protocol adjustment and will allow the effects of prehospital LTOWB on survival to be appropriately characterized. Abstract : INTRODUCTION: Low titer group O whole blood (LTOWB) resuscitation is increasingly common in both military and civilian settings. Data regarding the safety and efficacy of prehospital LTOWB remain limited. METHODS: We performed a single-center, prospective, cluster randomized, prehospital through in-hospital whole blood pilot trial for injured air medical patients. We compared standard prehospital air medical care including red cell transfusion and crystalloids followed by in-hospital component transfusion to prehospital and in-hospital LTOWB resuscitation. Prehospital vital signs were used as inclusion criteria (systolic blood pressure ≤90 mm Hg and heart rate ≥108 beats per minute or systolic blood pressure ≤70 mm Hg for patients at risk of hemorrhage). Primary outcome was feasibility. Secondary outcomes included 28-day and 24-hour mortality, multiple organ failure, nosocomial infection, 24-hour transfusion requirements, and arrival coagulation parameters. RESULTS: Between November 2018 and October 2020, 86 injured patients were cluster randomized by helicopter base. The trial has halted early at 77% enrollment. Overall, 28-day mortality for the cohort was 26%. Injured patients randomized to prehospital LTOWB (n = 40) relative to standard care (n = 46) were similar in demographics and injury characteristics. Intent-to-treat Kaplan-Meier survival analysis demonstrated no statistical mortality benefit at 28 days (25.0% vs. 26.1%, p = 0.85). Patients randomized to prehospital LTOWB relative to standard care had lower red cell transfusion requirements at 24 hours ( p < 0.01) and a lower incidence of abnormal thromboelastographic measurements. No transfusion reactions during the prehospital or in-hospital phase of care were documented. CONCLUSION: Prehospital through in-hospital LTOWB resuscitation is safe and may be associated with hemostatic benefits. A large-scale clinical trial is feasible with protocol adjustment and would allow the effects of prehospital LTOWB on survival and other pertinent clinical outcomes to be appropriately characterized. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level II. Abstract :