Evolution of whole blood trauma resuscitation in childbearing age females: practice patterns and trends

Alexandra Mp Brito; Mark H Yazer; Jason L Sperry; James F Luther; Stephen R Wisniewski; Frances Guyette; Ernest E Moore; Bryan A Cotton; Laura Vincent; Erin Fox; Jeremy W Cannon; Nicholas Namias; Joseph P Minei; Lee Anne Ammons; Skye Clayton; Martin Schreiber

doi:10.1136/tsaco-2024-001587

Evolution of whole blood trauma resuscitation in childbearing age females: practice patterns and trends

Trauma Surg Acute Care Open. 2024 Dec 7;9(1):e001587. doi: 10.1136/tsaco-2024-001587. eCollection 2024.

Authors

Alexandra Mp Brito¹, Mark H Yazer², Jason L Sperry³, James F Luther⁴, Stephen R Wisniewski⁴, Frances Guyette⁵, Ernest E Moore⁶, Bryan A Cotton⁷, Laura Vincent³, Erin Fox⁷, Jeremy W Cannon³, Nicholas Namias⁸, Joseph P Minei⁹, Lee Anne Ammons⁶, Skye Clayton¹⁰, Martin Schreiber¹

Affiliations

¹ Donald D Trunkey Center for Civilian and Combat Casualty Care, Oregon Health and Science University, Portland, Oregon, USA.
² Department of Pathology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
³ Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA.
⁵ Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶ Department of Surgery, Ernest E Moore Shock Trauma Center, Denver Health Medical Center, Denver, Colorado, USA.
⁷ Department of Surgery, University of Texas Health Science Center, Houston, Texas, USA.
⁸ Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.
⁹ Surgery, UT Southwestern, Dallas, Texas, USA.
¹⁰ Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

Background: The use of low titer group O whole blood (LTOWB) for resuscitation of patients with traumatic hemorrhage is becoming increasingly common. Practices regarding the administration of RhD-positive LTOWB to childbearing age females (CBAFs) vary between institutions due to concerns about RhD alloimmunization. This study examined practices related to LTOWB transfusion as they pertain to age and sex.

Methods: This was a secondary analysis of the Shock, Whole blood, and Assessment of TBI (traumatic brain injury) trial, a prospective, multicenter observational cohort study where outcomes following LTOWB transfusion were analyzed at seven level 1 trauma centers between 2018 and 2021, as well as a survey on transfusion practices at these centers conducted in 2023. The proportion of patients who received LTOWB or components was examined over the course of the study and grouped by age and sex, and the RhD group of injured CBAFs was documented.

Results: A total of 1046 patients were evaluated: 130 females aged <50 years (CBAFs), 77 females aged ≥50 years; 661 males aged <50 years, and 178 males aged ≥50 years. Among them, 26.2% of CBAFs received RhD-positive LTOWB, whereas 57.1%-66.3% of other sex/age groups received LTOWB. The proportion of CBAFs who received LTOWB increased significantly throughout the 4 years of this study. Except for older women in years 2 and 4, CBAFs were significantly less likely to receive LTOWB than all other groups for the study period and individual years. Among the 33 CBAFs who received LTOWB and for whom an RhD type was available, 4/33 (12.1%) were RhD-negative, while 9/95 (9.5%) CBAFs who received component therapy were RhD-negative. RhD blood product selection practices varied considerably between institutions.

Conclusions: Many institutions transfused LTOWB to CBAFs. Policies regarding RhD product selection varied. Of the total cohort, the proportion of RhD-negative CBAFs who received LTOWB increased over time but remained lower than all other groups.

Level of evidence: 3.

Keywords: resuscitation; transfusion; whole blood.