ABSTRACTS
Reduced Mortality with Prehospital Whole Blood in the Hemorrhaging Trauma PatientAuthor: Christopher Winckler, MD, LP, FAEMS | | Associate Authors: Remle Crowe, PhD, FAEMS, Michael Stringfellow, BS, EMT-P, William Bullock, BS, EMT-P, Lawrence Roakes, Riley Wampler, Andrew Liang, Julian Mapp, MD, MPH, Maxwell Braverman, MD, Donald Jenkins, MD, David Wampler, PhD, LP
Introduction Hemorrhage is the most common cause of preventable death in the trauma patient. Prehospital low-titer O+ whole blood (LTOWB) has been gaining popularity in recent years, but safety and efficacy have yet to be fully explored. Objective To determine the association of prehospital LTOWB with hospital mortality in patients with trauma. Methods This was a retrospective cohort study conducted from January 1, 2019 to December 31, 2022 using linked records from a large metropolitan fire-based EMS service and the state trauma registry. The intervention group consisted of patients meeting transfusion criteria (lowest prehospital systolic blood pressure [SBP] of < 100 mm Hg) who received LTOWB by EMS. To assemble a control group that would have likely been eligible for LTOWB, we included patients with a lowest SBP < 100 mm Hg who then received LTOWB in the emergency department (ED). Patients with prehospital cardiac arrest were excluded. We used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) comparing survival for patients who received prehospital LTOWB to those who received whole blood in the ED, controlling for age, sex, prehospital advanced airway, lowest prehospital SBP, Injury Severity Score, head injury, and mechanism (blunt/penetrating). As a sensitivity analysis, we performed multiple imputation by chained equations with 10 imputations and recalculated the regression model. Results We analyzed 669 patients meeting inclusion criteria: 57.6% (385) received prehospital LTOWB (median age: 33 [IQR: 24–45] years, male: 80.8%, penetrating injury: 80.8%) and 42.4% received ED whole blood only (median age: 36.5 [IQR: 28–54] years, male: 78.5%, penetrating injury: 35.0%). Survival in the prehospital LTOWB group was 83.4% versus 73.9% in the control group (p < 0.01). After adjustment, prehospital LTOWB was associated with a twofold increase in odds of survival (aOR: 2.01, 95% CI: 1.08–3.77). Results following multiple imputation were similar (aOR: 2.28, 95% CI: 1.29–4.07). Conclusion Adult trauma patients meeting transfusion criteria had twofold odds of survival benefit if the LTOWB transfusion was initiated by EMS prior to arrival at the trauma center. Limitations include the evaluation of a single study site and potential for residual confounders.
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