背景:在接下来的30年中,预计老年患者将占创伤入院的40%。全血(WB)的使用已显示出在降低血液制品的利用率的同时改善死亡率的希望。然而,尚未检查WB在老年创伤患者中的使用情况。我们研究的目的是确定WB首次输血策略在受伤的老年患者中的安全性和有效性。
方法:老年创伤患者,定义为年龄≥55岁,从2016年3月至2021年11月进行了审查。将接受WB首次复苏策略的患者与接受基于比率的成分策略的患者进行比较。人口统计以及并发症发生率,输血量,和死亡率进行了评估。使用单变量和多变量分析来确定死亡率的独立预测因子。
结果:有388名老年创伤患者在研究期间接受了任何血液制品。大多数患者接受了WB首次复苏策略(83%)。与接受成分治疗的患者相比,首先接受WB的患者更可能是女性,不太可能有穿透机制,损伤严重程度评分略低。30天死亡率相当(WB36%vs组件37%,p=0.914)。虽然在接受WB的患者中,AKI的发生率略高,这并没有导致肾脏替代疗法的发生率增加(3%vs2%,p=1)。Further,与接受组件的患者相比,用WB优先策略复苏的患者显著利用较低的中位血小板体积(0mLvs197mL,p<0.001),血浆中位体积(0mLvs1253mL,p<0.001,血液制品的中位总体积(1000毫升vs2859毫升,p<0.001)。
结论:在老年创伤患者中使用WB似乎是安全的,死亡率和并发症发生率与成分治疗相当。首先用WB复苏的血液产品利用率明显较低。
BACKGROUND: Older patients are expected to comprise 40 % of trauma admissions in the next 30 years. The use of whole blood (WB) has shown promise in improving mortality while lowering the utilization of blood products. However, the use of WB in older trauma patients has not been examined. The objective of our study is to determine the safety and efficacy of a WB first transfusion strategy in injured older patients.
METHODS: Older trauma patients, defined as age ≥55 years old, were reviewed from March 2016-November 2021. Patients that received a WB first resuscitation strategy were compared to those that received a ratio based component strategy. Demographics as well as complications rates, blood product transfusion volumes, and mortality were evaluated. Univariate and multivariable analysis was used to determine independent predictors of mortality.
RESULTS: There were 388 older trauma patients that received any blood products during the study period. A majority of patients received a WB first resuscitation strategy (83 %). Compared to patients that received component therapy, patients that received WB first were more likely female, less likely to have a penetrating mechanism, and had a slightly lower injury severity score. The-30 day mortality rate was comparable (WB 36% vs component 37 %, p = 0.914). While rates of AKI were slightly higher in those that received WB, this did not result in increased rates of renal replacement therapy (3 % vs 2 %, p = 1). Further, compared to patients that received components, patients that were resuscitated with a WB first strategy significantly utilized lower median volumes of platelets (0 mL vs 197 mL, p < 0.001), median volumes of plasma (0 mL vs 1253 mL, p < 0.001, and median total volume of blood products (1000 mL vs 2859 mL, p < 0.001).
CONCLUSIONS: The use of WB in the older trauma patient appears safe, with mortality and complication rates comparable to component therapy. Blood product utilization is significantly less in those that are resuscitated with WB first.