Information de reference pour ce titreAccession Number: | 01586154-202205000-00009.
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Author: | Guyette, Frank X. MD, MPH; Zenati, Mazen MD, PhD; Triulzi, Darrell J. MD; Yazer, Mark H. MD; Skroczky, Hunter BS; Early, Barbara J. BSN; Adams, Peter W. BS; Brown, Joshua B. MD, MCS; Alarcon, Louis MD; Neal, Matthew D. MD; Forsythe, Raquel M. MD; Zuckerbraun, Brian S. MD; Peitzman, Andrew B. MD; Billiar, Timothy R. MD; Sperry, Jason L. MD, MPH
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Institution: | From the Department of Emergency Medicine (F.X.G.), Department of Surgery (M.Z., J.B.B., L.A., M.D.N., R.M.F., B.S.Z., A.B.P., T.R.B., J.L.S.), Department of Pathology (D.J.T., M.H.Y.), Institute for Transfusion Medicine, and Department of Critical Care Medicine (H.S., B.J.E., P.W.A.), University of Pittsburgh, Pittsburgh, Pennsylvania.
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Title: | |
Source: | Journal of Trauma and Acute Care Surgery. 92(5):839-847, May 2022.
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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.
(C) 2022 Lippincott Williams & Wilkins, Inc.
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Author Keywords: | Low titer type O whole blood; randomized; pilot trial.
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Language: | English.
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Document Type: | 2021 AAST QUICK SHOT.
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ISSN: | 2163-0755
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DOI Number: | https://dx.doi.org/10.1097/TA.00...- ouverture dans une nouvelle fenêtre
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