Safety and efficacy of low-titer O whole blood resuscitation in a civilian level I trauma center.

Background Military experience has shown low-titer O whole blood (LTOWB) to be safe and beneficial in the resuscitation of hemorrhaging trauma patients. However, few civilian centers utilize LTOWB for trauma resuscitation. We evaluated the early experience and safety of a LTOWB program at a Level 1 civilian trauma center. Methods We retrospectively reviewed our trauma registry from January 2018-June 2020 for patients admitted in shock (defined as ≥1 of the following: heart rate > 120 beats per minute, systolic blood pressure [SBP] 0.9) who received blood products within 24 hours (h). Patients were grouped by resuscitation provided: LTOWB (Group 1), component therapy (CT; Group 2), and LTOWB+CT (Group 3). Safety, outcomes, and variables associated with LTOWB transfusion and mortality were analyzed. Results 216 patients were included: 34 in Group 1, 95 in Group 2, and 87 in Group 3. Patients receiving LTOWB were more commonly male (p 0.05). Arrival ED SBP was associated with LTOWB transfusion (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.95-1.00, p = 0.03). ED lactate was independently associated with 24 h mortality. (OR 1.27, CI 1.02-1.58, p = 0.03). LTOWB transfusion was not associated with mortality (p = 0.49). Conclusions Severely injured patients received LTOWB+CT and more overall product units but had similar 24 h mortality when compared to the LTOWB or CT groups. No increase in transfusion-related complications was seen after LTOWB transfusion. LTOWB should be strongly considered in the resuscitation of trauma patients at civilian centers. Level of evidence Retrospective study having more than one negative criterion; level IV evidence; therapeutic.