Whole blood resuscitation is associated with decreased end-organ dysfunction in pediatric trauma patients.

Abstract

Low Titer Group O Whole Blood (WB) has emerged as a safe and efficient therapeutic agent for hemostatic resuscitation in injured children. The relationship between type of blood product transfused and incidence of organ dysfunction is not well elucidated. We hypothesize that WB transfusion is associated with decreased organ dysfunction compared with component therapy (CT). This is a retrospective observational study of injured children ages 0 year to 17 years utilizing the TQIP database (2020-2022). Inclusion criteria were receipt of any blood product within 4 hours of ED arrival and survival to 72 hours. Subjects were categorized by receipt of WB. Primary outcome was organ dysfunction, defined as presence of any of the following: mechanical ventilation greater than 6 days, sepsis, acute respiratory distress syndrome, pneumonia, acute kidney injury, urinary tract infection, or myocardial infarction. Data were analyzed using logistic regression, adjusting for age, sex, trauma mechanism, Injury Severity Score, head abbreviated injury score, Glasgow Coma Scale, shock (SIPA score), interfacility transfer, weight-adjusted volume of each blood product (mL/kg) and site. Of 6237 subjects analyzed, 907 (14.5%) received WB and 2421 (38.8%) had evidence of organ dysfunction, with respiratory failure being most common (1689 [27%]). In the analysis cohort, the median (IQR) age was 15 years (10-17), 42.7% penetrating mechanism, median (IQR) injury severity score 24 (14-43), median (IQR) total transfusion volume 16.4 mL/kg (8.2-35), and median (IQR) WB transfusion volume 12 mL/kg (7-20). In the adjusted model, WB transfusion was associated with decreased odds of organ dysfunction (odds ratio, 0.78; 95% confidence interval, 0.61-0.98; p = 0.04). Sensitivity analysis including subjects who died within 72-hours did not show a significant difference, suggesting minimal influence of survival bias. Early WB resuscitation was independently associated with reduced organ dysfunction in injured children. Further large, prospective, and mechanistic studies are needed. Therapeutic/Care Management; Level III.