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Blunt trauma outcomes improved by early transfusion

Major finding: Patients transfused before arrival at a trauma center showed a 95% lower 24-hour mortality rate, a 64% lower 30-day mortality rate, and an 88% lower risk of trauma-induced coagulopathy.

Data source: Secondary retrospective analysis of data from a prospective cohort study on 1,415 patients with blunt injury and hemorrhagic shock who arrived at a trauma center within 2 hours of injury.

Disclosures: Dr. Brown reported having no financial disclosures.

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Prospective study warranted

The role of blood-based resuscitation in salvaging the severely injured patient remains an area of intense scrutiny. We spend a lot of time at meetings talking about this very subject.

The authors note that there are multiple studies that have looked at blood-based resuscitation, including things like blood to plasma and platelet ratios, the timing of blood product transfusion, and the use of institutional transfusion protocols. Sometimes they give completely different answers.

Despite these variabilities, I think what we are seeing is that early use of blood products in the correct patient population does result in better survival. It’s a logical question for the trauma researcher to then ask, how early should blood be given? How early can blood be given?

The authors identified over 1,400 patients who met inclusion criteria. Ultimately, they demonstrated a statistically significant benefit to prehospital transfusion in terms of both 24-hour and 30-day mortality as well as trauma-induced coagulopathy. These are very intriguing results.

They state that the median volume of blood transfused prior to reaching the trauma center was 1.3 units, ranging from 1-2.3 units. I wonder how they can explain the fact that 1 unit of prehospital blood resulted in such a significant difference in mortality and coagulopathy. That is a lot of bang for your buck.

The low numbers in the prehospital transfusion group raise some questions, but I do agree that this is interesting research and it is worthy of prospective study.

Dr. Stephanie Savage is a surgeon at the University of Tennessee, Memphis. These are excerpts of her remarks as discussant of the study at the meeting. She reported having no financial disclosures.


 

AT THE AAST ANNUAL MEETING

SAN FRANCISCO – Giving patients severely injured by blunt trauma a blood transfusion before they arrived at a trauma center was associated with a 95% reduction in deaths within 24 hours and a 64% reduction in deaths within 30 days, a retrospective study of 1,415 patients found.

Transfusion before arrival at the trauma center also was associated with an 88% reduction in the incidence of trauma-induced coagulopathy, Dr. Joshua B. Brown and his associates reported at the annual meeting of the American Association for the Surgery of Trauma.

They analyzed data from the prospective Inflammation and Host Response to Injury cohort study for patients with blunt injury in hemorrhagic shock who arrived at a trauma center within 2 hours of injury, 50 of whom received a blood transfusion before arrival. The investigators found that prearrival blood transfusion was associated with better outcomes after controlling for the effects of demographics, time to the trauma center, the severity of injury and shock, early resuscitation, and other confounders.

These preliminary data are compelling but require prospective validation, said Dr. Brown of the University of Pittsburgh.

Prehospital resuscitation of patients severely injured by blunt trauma has focused on use of crystalloids, and the next logical step is to bring blood-based resuscitation to prehospital settings, he said. Hemorrhage and coagulopathy have been major causes of death in blunt trauma patients.

In the study, patients who got a transfusion before arrival at the trauma center received a median of 1.3 units of blood prearrival. They were more likely to be hypotensive and to have a lower base deficit compared with patients who were not transfused before arrival, suggesting a higher severity of injury and shock in the transfusion group, he said. The groups did not differ significantly in age, gender, or Injury Severity Score.

Patients who received a transfusion before arrival at a trauma center showed a 95% lower 24-hour mortality rate, a 64% lower 30-day mortality rate, and an 88% lower risk of trauma-induced coagulopathy.

In a subsequent matched cohort analysis of 113 patients from the study, those receiving a pre–trauma center transfusion (35 patients) had a 98% reduction in mortality at 24 hours, an 88% reduction in 30-day mortality, and a 99% reduction in the risk of trauma-induced coagulopathy, Dr. Brown reported.

Dr. Brown reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

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