Infection Risk in the Setting of Whole Blood Trauma Resuscitation: An Added Benefit?

Author(s):
Desmond Zeng; Victoria Addis; Sheri VandenBerg; Tjasa Hranjec; Robert Sawyer

Background:

Use of whole blood has become relatively common in trauma-related damage-control resuscitations, with an associated increase in survival. Component resuscitation has been implicated as a risk factor for infection via an immunosuppressive effect.

Hypothesis:

We hypothesized that infection rates would increase in patients receiving whole blood transfusion.

Methods:

A retrospective review of all adult trauma patients who received blood transfusions during initial resuscitation at a single community hospital over a two-year period was performed. Patients were stratified into 3 groups based on the type of transfusion received: whole blood only (WB), component transfusion only (RBC), or both (WB+RBC). Demographic and infection data were collected prospectively and analyzed retrospectively using univariate analysis accounting for multiple comparisons. Risk factors for infection and in-hospital mortality were evaluated using multivariate analysis.

Results:

A total of 277 patients were analyzed; most were male (70.8%) with mean age 50.9 ± 1.3 years old. Fifty-eight (20.9%) patients had one or more infection, lowest was noted in the WB group (13%). Patients in the WB+RBC group were more severely injured, more likely to require mechanical ventilation, had lower GCS score, received significantly more blood products, and had increased mortality. When adjusted for age, gender, infection, and injury type, WB transfusion resulted in 92% decreased risk of mortality compared to component transfusion.

The most important predictors of infection were injury severity, head trauma and transfusion type. When adjusted for risk factors, WB did not carry a statistically significant protective effect. Patients in the WB+RBC group had 2.6 times increased risk of infection, but this may be related to their injury severity.

Conclusions:

Whole blood transfusion for trauma patients during initial resuscitation was associated with a significant decrease in hospital mortality compared to component transfusion. Reduction in infection following WB transfusion was not statistically significant, likely due to the sample size. Whether this phenomenon is related to better resuscitation with whole blood or immunological changes is yet to be determined.