The use of whole blood in traumatic bleeding: a systematic review
- 15 September 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Internal and Emergency Medicine
- Vol. 16 (1), 209-220
- https://doi.org/10.1007/s11739-020-02491-0
Abstract
Hemostatic resuscitation is currently considered a standard of care for the management of life-threatening hemorrhage, but in some critical settings the access to high quantities of blood components is problematic. Whole blood (WB) transfusion has been proposed as an alternative modality for hemostatic resuscitation of traumatic major bleeding. To assess the efficacy and safety of WB in trauma-associated massive bleeding, we performed a systematic review of the literature. We selected studies comparing WB transfusions to transfusion of blood components (COMP) in massive trauma bleeding; both randomized clinical trial (RCT) and observational studies were considered. The outcomes were mortality (30-day/in-hospital and 24-h mortality) and adverse events/transfusion reactions. The effect sizes were crude odds ratio (OR), adjusted OR and hazard ratio (HR). The methodological quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs, and the ROBIN-1 tool for observational studies. The overall quality of the available evidence was assessed with the GRADE system. One RCT (2 reports) and 6 cohort studies were included (3642 adult patients; 675 receiving WB, 2967 receiving COMP). Three studies were conducted in military setting, and 4 in civilian setting. In the overall analysis, 30-day/in-hospital and 24-h mortality did not differ significantly between groups (very low quality of the evidence due to high risk of bias, imprecision and inconsistency). After adjustment for baseline covariates in three cohort studies, the OR for mortality was significantly lower in WB recipients compared to COMP (OR 0.22; 95% CIs 0.10/0.45) (moderate grade of evidence). Adverse events and transfusion reactions were overlooked and not consistently reported. The available evidence does not allow to draw definite conclusions on the short-term and long-term efficacy and safety of WB transfusion compared to COMP transfusion. Further well designed research is needed.This publication has 56 references indexed in Scilit:
- A Randomized Controlled Pilot Trial of Modified Whole Blood versus Component Therapy in Severely Injured Patients Requiring Large Volume TransfusionsAnnals of Surgery, 2013
- Military walking blood bank and the civilian blood serviceTransfusion and Apheresis Science, 2012
- Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian settingTransfusion, 2010
- Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME)Transfusion, 2010
- Warm Fresh Whole Blood Is Independently Associated With Improved Survival for Patients With Combat-Related Traumatic InjuriesThe Journal of Trauma and Acute Care Surgery, 2009
- Increased Plasma and Platelet to Red Blood Cell Ratios Improves Outcome in 466 Massively Transfused Civilian Trauma PatientsAnnals of Surgery, 2008
- Transfusion practice in military traumaTransfusion Medicine, 2008
- What is “quality of evidence” and why is it important to clinicians?BMJ, 2008
- Preventable Deaths From Hemorrhage at a Level I Canadian Trauma CenterThe Journal of Trauma and Acute Care Surgery, 2007
- Whole blood transfusionTransfusion, 1986