Abstract：
Following COVID and the subsequent blood shortage, several investigators evaluated futility cut points in massive transfusion. We hypothesized that early aggressive use of damage-control resuscitation, including whole blood (WB), would demonstrate that these cut points of futility were significantly underestimating potential survival among patients receiving >50 U of blood in the first 4 hours.
Adult trauma patients admitted from November 2017 to October 2021 who received emergency-release blood products in prehospital or emergency department setting were included. Deaths within 30 minutes of arrival were excluded. Total blood products were defined as total red blood cell, plasma, and WB in the field and in the first 4 hours after arrival. Patients were first divided into those receiving ≤50 or >50 U of blood in the first 4 hours. We then evaluated patients by whether they received any WB or received only component therapy. Thirty-day survival was evaluated for all included patients.
A total of 2,299 patients met the inclusion criteria (2,043 in ≤50 U, 256 in >50 U groups). While there were no differences in age or sex, the >50 U group was more likely to sustain penetrating injury (47% vs. 30%, p < 0.05). Patients receiving >50 U of blood had lower field and arrival blood pressure and larger prehospital and emergency department resuscitation volumes ( p < 0.05). Patients in the >50 U group had lower survival than those in the ≤50 cohort (31% vs. 79%; p < 0.05). Patients who received WB (n = 1,291) had 43% increased odds of survival compared with those who received only component therapy (n = 1,008) (1.09-1.87, p = 0.009) and higher 30-day survival at transfusion volumes >50 U.
Patient survival rates in patients receiving >50 U of blood in the first 4 hours of care are as high as 50% to 60%, with survival still at 15% to 25% after 100 U. While responsible blood stewardship is critical, futility should not be declared based on high transfusion volumes alone.
Therapeutic/Care Management; Level III.
Adult trauma patients admitted from November 2017 to October 2021 who received emergency-release blood products in prehospital or emergency department setting were included. Deaths within 30 minutes of arrival were excluded. Total blood products were defined as total red blood cell, plasma, and WB in the field and in the first 4 hours after arrival. Patients were first divided into those receiving ≤50 or >50 U of blood in the first 4 hours. We then evaluated patients by whether they received any WB or received only component therapy. Thirty-day survival was evaluated for all included patients.
A total of 2,299 patients met the inclusion criteria (2,043 in ≤50 U, 256 in >50 U groups). While there were no differences in age or sex, the >50 U group was more likely to sustain penetrating injury (47% vs. 30%, p < 0.05). Patients receiving >50 U of blood had lower field and arrival blood pressure and larger prehospital and emergency department resuscitation volumes ( p < 0.05). Patients in the >50 U group had lower survival than those in the ≤50 cohort (31% vs. 79%; p < 0.05). Patients who received WB (n = 1,291) had 43% increased odds of survival compared with those who received only component therapy (n = 1,008) (1.09-1.87, p = 0.009) and higher 30-day survival at transfusion volumes >50 U.
Patient survival rates in patients receiving >50 U of blood in the first 4 hours of care are as high as 50% to 60%, with survival still at 15% to 25% after 100 U. While responsible blood stewardship is critical, futility should not be declared based on high transfusion volumes alone.
Therapeutic/Care Management; Level III.
摘要：
背景：在COVID和随后的血液短缺之后，一些研究者评估了大量输血中的无效性.我们假设早期，积极使用损伤控制复苏，包括全血（WB），将证明这些无效性的分界点显著低估了在前4小时内接受>50单位血液的患者的潜在生存率。
方法：纳入2017年11月至2021年10月收治的在院前或ED设置中接受紧急放血的成人创伤患者。不包括到达后30分钟内的死亡。总血液制品定义为总红细胞，等离子体,WB在野外和抵达后的前4小时。首先将患者分为在前4小时内接受≤50或>50单位血液的患者。然后，我们通过患者是否接受任何WB或仅接受成分治疗（COMP）来评估患者。评估所有纳入患者的30天生存率。
结果：2,299例患者符合纳入标准（2,043例≤50U，256in>50U组)。虽然年龄或性别没有差异，>50U组更有可能发生穿透性损伤(47%vs30%，p<0.05)。接受>50U血液的患者的视野和到达血压较低，院前和ED复苏量较大（p<0.05）。>50U组患者的生存率低于≤50组患者（31vs79％；p<0.05）。与接受COMP（n=1,291）的患者相比，接受WB（n=1,291）的患者的生存几率增加了43％（1.09-1.87，p=0.009），并且在输血量>50U时的30天生存率更高。
结论：在治疗的前4小时内接受>50单位血液的患者的患者生存率高达50-60％，100个单位后存活率仍为15-25%。虽然负责任的血液管理至关重要，不应仅基于高输血量就宣布无效。
方法：三级，没有阴性标准的回顾性比较研究。
方法：纳入2017年11月至2021年10月收治的在院前或ED设置中接受紧急放血的成人创伤患者。不包括到达后30分钟内的死亡。总血液制品定义为总红细胞，等离子体,WB在野外和抵达后的前4小时。首先将患者分为在前4小时内接受≤50或>50单位血液的患者。然后，我们通过患者是否接受任何WB或仅接受成分治疗（COMP）来评估患者。评估所有纳入患者的30天生存率。
结果：2,299例患者符合纳入标准（2,043例≤50U，256in>50U组)。虽然年龄或性别没有差异，>50U组更有可能发生穿透性损伤(47%vs30%，p<0.05)。接受>50U血液的患者的视野和到达血压较低，院前和ED复苏量较大（p<0.05）。>50U组患者的生存率低于≤50组患者（31vs79％；p<0.05）。与接受COMP（n=1,291）的患者相比，接受WB（n=1,291）的患者的生存几率增加了43％（1.09-1.87，p=0.009），并且在输血量>50U时的30天生存率更高。
结论：在治疗的前4小时内接受>50单位血液的患者的患者生存率高达50-60％，100个单位后存活率仍为15-25%。虽然负责任的血液管理至关重要，不应仅基于高输血量就宣布无效。
方法：三级，没有阴性标准的回顾性比较研究。
