Robert van der Horst (Leiderdorp / NL), Tim Rijnhout (Leiderdorp / NL), Femke Noorman (Utrecht / NL), Boudewijn Borger van der Burg (Leiderdorp / NL), Oscar van Waes (Rotterdam / NL), Michael H.J. Verhofstad (Rotterdam / NL), Rigo Hoencamp (Leiderdorp / NL)
Abstract text (incl. references and figure legends)
Introduction
Whole blood (WB) transfusion received renewed interest after recent armed conflicts. Despite the possible benefits of WB, effectiveness of WB as compared to blood component transfusion (BCT) is still topic of debate. Therefore, we investigated whether WB ± BCT transfusion results in a survival benefit as compared to BCT in patients with acute hemorrhage.
Material & Methods
Electronic databases were searched from inception to 14th of September. Studies comparing resuscitation with WB (with or without BCT) to BCT only in patients with traumatic hemorrhage were included in the meta-analysis. Sub analyses were performed on the effectiveness of WB in the treatment of massive hemorrhage and on platelet (PLT):Red Blood Cell (RBC), plasma:RBC and WB:RBC ratios. Methodological quality of studies was interpreted using the Cochrane risk of bias tool.
Results
Random effect pooled odds ratio (OR) for 24-hours mortality in civilian and military patients was 0.72 (95% CI 0.53 - 0.97). In sub analysis of studies conducted in civilian setting (n=11), early (4-hours, 6-hours and Emergency Department) and 24-hours mortality were reduced in WB groups compared BCT groups: OR 0.65 (95% CI 0.44 – 0.96) and OR 0.71 (0.52 – 0.98). WB groups received significant higher PLT:RBC (p=0.030) during early treatment and significant higher PLT:RBC and Plasma:RBC ratios during 24-hours of treatment (p=0.031 and p=0.007). Transfusion ratios did correlate for early Plasma:RBC ratio and early mortality (WB±BCT, R2 = 0.79 and BCT, R2 = 0.95). The overall risk of bias in the majority of studies was judged as serious due to serious risk on confounding and selection bias, and unclear information regarding co-interventions.
Conclusions
Civilian trauma patients with acute hemorrhage had lower odds on early and 24-hours mortality when treated with WB and BCT as compared to BCT only. Due to serious risk of bias, superiority or inferiority of WB as compared to BCT remains to be demonstrated. Nevertheless, WB is an important adjunct in the treatment of traumatic hemorrhage due to logistical benefits.
Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)
I and co-authors declare no conflicts of interest for the study entitled: ''Whole blood transfusion in the treatment of civilian and military trauma patients with acute hemorrhage, a systematic review and meta-analysis''