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Master of Public Health

Patients with Both Traumatic Brain Injury and Hemorrhagic Shock Benefit from Resuscitation with Whole Blood

AUTHORS

Hatton GE , Brill JB , Tang B , Mueck KM , McCoy CC , Kao LS , Cotton BA , . The journal of trauma and acute care surgery. 2023 7 24; ().

ABSTRACT

INTRODUCTION: Hemorrhagic shock in the setting of traumatic brain injury (TBI) reduces cerebral blood flow and doubles mortality. The optimal resuscitation strategy for hemorrhage in the setting of TBI is unknown. We hypothesized that, among patients presenting with concomitant hemorrhagic shock and TBI, resuscitation including whole blood (WB) is associated with decreased overall and TBI-related mortality when compared to patients receiving component (COMP) therapy alone.

METHODS: An a priori subgroup of prospective, observational cohort study of injured patients receiving emergency-release blood products for hemorrhagic shock is reported. Adult trauma patients presenting 11/2017-9/2020 with TBI, defined as a Head Abbreviated Injury Scale of ≥3, were included. WB group patients received any cold-store low-titer Group O WB units. The COMP group received fractionated blood components alone. Overall and TBI-related 30-day mortality, favorable discharge disposition (home or rehabilitation), and 24-hour blood product utilization were assessed. Univariate and inverse probability of treatment-weighted multivariable analyses were performed.

RESULTS: Of 564 eligible patients, 341 received WB. Patients who received WB had a higher injury severity score (median 34 vs 29), lower scene blood pressure (104 vs 118), and higher arrival lactate (4.3 vs 3.6, all p < 0.05). Univariate analysis noted similar overall mortality between WB and COMP; however, weighted multivariable analyses found WB was associated with decreased overall mortality and TBI-related mortality. There were no differences in discharge disposition between the WB group and COMP group.

CONCLUSION: In patients with concomitant hemorrhagic shock and TBI, WB transfusion was associated with decreased overall mortality and TBI-related mortality. WB should be considered a first-line therapy for hemorrhage in the setting of TBI.

LEVEL OF EVIDENCE: III; Type of Study: Therapeutic.

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