Don't break the bank: Description of survivors in high-volume transfusion and utility of transfusion in trauma.

Abstract

In response to blood shortages, providers face pressure to conserve blood. No metrics exist to calculate transfusion utility. We describe characteristics of survivors after high-volume resuscitation and evaluate transfusion utility in low-volume and high-volume resuscitation. A retrospective analysis of 2019 American College of Surgeons Trauma Quality Improvement Program was performed on trauma patients ≥16 years old receiving transfusion within 4 hours of arrival. Patients excluded if they died in the emergency department, were dead on arrival, received <2 units of packed red blood cells, did not receive fresh-frozen plasma, or were missing data. High-volume survivors received more blood than 95% of the surviving population (≥17 U of packed red blood cells). High-volume mortality patients received ≥17 U of packed red blood cells and did not survive to discharge. Characteristics of high-volume survivors were identified by multivariable logistic regression. Utility of transfusion was compared between low-volume (<17 U of packed red blood cells) and high-volume (≥17 U of packed red blood cells) groups by totaling U transfused to yield 1 survivor. In total, 17,407 patients met study criteria, 12,585 (72%) survived. A total of 5.3% (663/12,585) of survivors were high-volume survivors. In total, 23% (1,112/4,823) of mortalities received ≥17 U of packed red blood cells. Low-volume survivors received a greater proportion of product than high-volume survivors (71% vs 34%, P < .001). Low-volume transfusions better used the blood supply (12.6 vs 130.8 U per survivor, P < .001). High-volume resuscitation yields few survivors and strains the blood supply. Standardized assessment protocols should identify patients with a favorable survival profile to guide allocation. Units transfused per survivor can be used to monitor the effect that blood-conservation protocols have on transfusion utility.