LAUSR

OBJECTIVE Early close ratio transfusion with balanced component therapy (BCT) has been associated with improved outcomes in patients with severe hemorrhage; however, this modality is not comparable with WB constituents. We compared use of BCT vs. WB to determine if one yielded superior outcome in patients with severe hemorrhage. We hypothesized that WB would lead to reduced in-hospital mortality and blood product volume given in the first 24 hours of admission. STUDY DESIGN This was a 1-year single institution prospective, observational study comparing BCT to WB in adult (18+) trauma patients with active hemorrhage who required blood transfusion upon arrival to the emergency department. Primary endpoint was in-hospital mortality. Secondary endpoints included 24-hour transfusion volumes, in-hospital clinical outcomes and complications. RESULTS A total of 253 patients were included, of which 71.1% received BCT and 29.9% WB. The WB cohort had significantly more penetrating trauma (64.4% vs 48.9%; P=0.03) and higher Shock Index (1.12 vs 0.92; P=0.04). WB patients received significantly fewer units of PRBCs (P<0.001) and FFP (P = 0.04) with lower incidence of acute respiratory distress syndrome (ARDS) (P=0.03) and shorter ventilator days (P=0.03). Kaplan Meier survival analysis revealed no difference in survival between the two transfusion strategies (P=0.80). When adjusted for various markers of injury severity and critical illness in Cox regression analysis, WB remained unassociated with mortality (HR: 1.25; 95% CI 0.60 - 2.58; P = 0.55). CONCLUSION There was no difference in survival rates when comparing BCT to WB. In the WB group the incidence of ARDS, duration of mechanical ventilation, MTP activation, and transfusion volumes were significantly reduced. Further research should be directed on analyzing if there is a true hemorrhage-related pathophysiologic benefit of WB when compared to BCT.