Whole Blood Plus MTP Associated With Improved Survival in Patients With Severe Bleeding

Receipt of whole blood in addition to component therapy-based massive transfusion protocol (MTP) was associated with improved survival in trauma patients with severe hemorrhage compared to MTP alone, new research suggests. Investigators published their findings last Wednesday in JAMA Surgery.

In this retrospective cohort study, investigators reviewed data from the American College of Surgeons Trauma Quality Improvement Program (TQIP) databank to assess outcomes for patients who presented with severe traumatic hemorrhage at level I and II trauma centers in the United States or Canada. Patients who had a systolic blood pressure less than 90 millimeters of mercury (mm Hg) and a shock index greater than 1 who received at least 4 units of red blood cells within the first hour of emergency department (ED) arrival were included. Primary outcomes were survival at 24 hours and 30 days.

A total of 2,785 patients met the inclusion criteria: 432 who received whole blood and component therapy-based MTP (WB-MTP) and 2,353 patients who received MTP alone. A survival curve demonstrated separation within 5 hours of presentation in the emergency department. 

At 24 hours, those who received WB-MTP had a 37% lower risk of mortality (hazard ratio, 0.63; 95% CI, 0.41-0.96; P = .03) compared to patients who received MTP alone. The survival benefit associated with WB-MTP remained consistent at 30 days (HR, 0.53; 95% CI, 0.31-0.93; P = .02).

According to investigators, the findings are an essential first step in prioritizing the selection of WB-MTP for trauma patients presenting with severe hemorrhage. In a JAMA Surgery Author Interview, lead author Crisanto M. Torres, MD, MPH, and co-author Joseph V. Sakran, MD, MPH, MPA, discussed their findings and shared the next steps in their research: evaluating the timing and impact of whole blood transfusions on clinical outcomes among patients who received WB-MTP.

“It’s so exciting to be at the moment we’re in where we’re starting to collect robust data that’s allowing us to figure out, in patients that are arriving to our trauma centers, how do we adequately resuscitate them to ensure we’re providing them with the best possible chance for survival,” Sakran said.