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Whole blood transfusion versus component therapy in adult trauma patients with acute major haemorrhage
  1. Pascale Avery1,2,
  2. Sarah Morton3,
  3. Harriet Tucker2,4,5,
  4. Laura Green2,6,7,
  5. Anne Weaver2,8,9,
  6. Ross Davenport2,10
  1. 1Emergency Department, North Bristol NHS Trust, Bristol, UK
  2. 2Trauma Sciences, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK
  3. 3Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
  4. 4Air Ambulance Kent Surrey Sussex, Kent, UK
  5. 5Emergency Department, St George’s University Hospitals NHS Foundation Trust, London, UK
  6. 6Haematology Department, Barts Health NHS Trust, London, UK
  7. 7NHS Blood and Transplant, London, UK
  8. 8Emergency Department, Barts Health NHS Trust, London, UK
  9. 9London’s Air Ambulance, The Royal London Hospital, London, UK
  10. 10Trauma and Vascular Surgery, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Pascale Avery, Emergency Department, Southmead Hospital, Bristol BS10 5NB, UK; pascale.avery{at}nhs.net

Abstract

Objective In the era of damage control resuscitation of trauma patients with acute major haemorrhage, transfusion practice has evolved to blood component (component therapy) administered in a ratio that closely approximates whole blood (WB). However, there is a paucity of evidence supporting the optimal transfusion strategy in these patients. The primary objective was therefore to establish if there is an improvement in survival at 30 days with the use of WB transfusion compared with blood component therapy in adult trauma patients with acute major haemorrhage.

Methodology A systematic literature search was performed on 15 December 2019 to identify studies comparing WB transfusion with component therapy in adult trauma patients and mortality at 30 days. Studies which did not report mortality were excluded. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results Search of the databases identified 1885 records, and six studies met the inclusion criteria involving 3255 patients. Of the three studies reporting 30-day mortality (one randomised controlled trial (moderate evidence) and two retrospective (low and very low evidence, respectively)), only one study demonstrated a statistically significant difference between WB and component therapy, and two found no statistical difference. Two retrospective studies reporting in-hospital mortality found no statistical difference in unadjusted mortality, but both reported statistically significant logistic regression analyses demonstrating that those with a WB transfusion strategy were less likely to die.

Conclusion Recognising the limitations of this systematic review relating to the poor-quality evidence and limited number of included trials, it does not provide evidence to support or reject use of WB transfusion compared with component therapy for adult trauma patients with acute major haemorrhage.

PROSPERO registration number CRD42019131406.

  • trauma
  • emergency department
  • haematology
  • research
  • prehospital
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Footnotes

  • Contributors PA primary author and reviewer 1, SM reviewer 2, HT and LG revising drafts, AW and RD design and supervision. Each author has been involved in the development of the final material.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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