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Wisont T, Liu Z, Kmail Z, Stansbury LG, Theard MA, Vavilala MS, Hess JR. Racial-ethnicity group distributions of blood product use in acute trauma care transfusion. Transfusion 2024. [PMID: 39380561 DOI: 10.1111/trf.18030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 09/16/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Recent studies suggest Black patients are transfused less often and at lower hemoglobin levels than White patients. In elective surgery, Black and Non-White patients have greater estimated blood loss and transfusion frequency. We asked whether similar transfusion disparities are observable in acute trauma resuscitation. METHODS In a single-center retrospective analysis of trauma registry/blood-bank-linked data from a large US trauma center, we identified all acute trauma patients 2011-2022. Our data sources permitted distinction of Race and Ethnicity and therefor binning as Non-White-race/not Hispanic plus any-race/Hispanic or White/not Hispanic. We tallied Injury Severity Scores mild through profound (ISS 1-9, 9-15, 16-25, >25), type (blunt vs. penetrating) and mechanism (firearms, etc.), and associated blood use overall and in the first, first four, and first 24 h, comparing results with chi square, p < .01. RESULTS Overall, 50,394 (68.41%) acute trauma patients were classified as White and 23,251 (31.7%) as Other than White. White patients were more likely to receive any blood products (17.8% vs. 11.9%), but, for all measures of urgency/quantity, Non-White patients were transfused more often (respectively, first 4 h, 51.9% vs. 42.1%; ≥3u/first hour, 18.5% vs. 11.0%; ≥10u/24 h, 8.1% vs. 3.8%) (all p < .001). White patients were far more likely to have blunt injury than Non-White patients, (77.2% vs. 42.6%), less likely to have penetrating injury (10.1% vs. 14%) and far less likely to be injured by firearms (30.6% vs. 56.9%) (all p < .001). CONCLUSIONS At our center, blood use in acute trauma resuscitation was associated with injury severity and mechanism, not race/ethnicity.
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Affiliation(s)
- Tristan Wisont
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Zhinan Liu
- Department of Laboratory Medicine & Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Zaher Kmail
- School of Interdisciplinary Arts & Sciences, Division of Science & Mathematics, University of Washington, Tacoma, Washington, USA
| | - Lynn G Stansbury
- Department of Laboratory Medicine & Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - M Angele Theard
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine & Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Transfusion Service, Harborview Medical Center, Seattle, Washington, USA
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Liu Z, Kmail Z, Higgins M, Stansbury LG, Kunapaisal T, O'Connell KM, Bentov I, Vavilala MS, Hess JR. Blood transfusion in injured older adults: A retrospective cohort study. Transfus Med 2024. [PMID: 39340211 DOI: 10.1111/tme.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/23/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
OBJECTIVES We asked how increasing age interacts with transfusion and mortality among older injured adults at our large regional trauma center. BACKGROUND Older adults are increasing proportions of acute trauma care and transfusion, but the specific interactions of increasing age with blood product use are unclear. METHODS/MATERIALS Trauma data (age, injury severity, mechanism, etc.) were linked with transfusion service data (type, timing and numbers of units) for all acute trauma patients treated at our center 2011-2022. Subsets of patients aged ≥55 years were identified by age decade and trends assessed statistically, p < 0.01. RESULTS Of 73 645 patients, 25 409 (34.5%) were aged ≥55. Within increasing 10-year age cohorts, these older patients were increasingly female (32.2%-67.2%), transferred from outside facilities (55.2%-65.9%) and injured in falls (44.4%-90.3%). Overall, patients ≥55, despite roughly equivalent injury severity, were twice as likely to be transfused (24% vs. 12.8%) as younger patients and to die during hospitalisation (7.5% vs. 2.9%). Cohort survival at all ages and levels of transfusion intensity in the first 4 h of care were more than 50%. Through age 94, numbers of red cell and whole blood units given in the first 4 h of care were a function of injury severity, not age cohort. CONCLUSIONS In our trauma resuscitation practice, patients aged ≥55 years are more likely to receive blood products than younger patients, but numbers of units given in the first 4 h appear based on injury severity. Age equity in acute resuscitation is demonstrated.
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Affiliation(s)
- Zhinan Liu
- Department of Laboratory Medicine & Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Zaher Kmail
- School of Interdisciplinary Arts & Sciences, Division of Science & Mathematics, University of Washington, Tacoma, Washington, USA
| | - Mairead Higgins
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Lynn G Stansbury
- Department of Laboratory Medicine & Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Thitikan Kunapaisal
- Department of Anaesthesia, Prince of Songkla University Hospital, Songkla, Thailand
| | - Kathleen M O'Connell
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Itay Bentov
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine & Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Harborview Transfusion Service, Harborview Medical Center, Seattle, Washington, USA
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3
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Walters AM, Aichholz P, Muldowney M, Van Cleve W, Hess JR, Stansbury LG, Vavilala MS. Emergency Anesthesiology Encounters, Care Practices, and Outcomes for Patients with Firearm Injuries: A 9-Year Single-Center US Level 1 Trauma Experience. Anesth Analg 2024:00000539-990000000-00920. [PMID: 39178169 DOI: 10.1213/ane.0000000000007152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
BACKGROUND Firearm injuries cause significant morbidity and mortality. Patients with firearm injuries require urgent/emergency operative procedures but the literature incompletely describes how anesthesia care and outcomes differ between high acuity trauma patients with and without firearm injuries. Our objective was to examine anesthesia care, resource utilization, and outcomes of patients with acute firearm injuries compared to nonfirearm injuries. METHODS We conducted a retrospective cross-sectional study of patients ≥18 years admitted to a regional Level 1 trauma center between 2014 and 2022 who required operative management within the first 2 hours of hospital arrival. We examined clinical characteristics, anesthesiology care practices, and intra- and postoperative outcomes of patients with firearm injuries compared to patients with nonfirearm injuries. RESULTS Over the 9-year study period, firearm injuries accounted for the largest yearly average increase in trauma admissions (firearm 10.1%, blunt 3.2%, other 1.3%, motor-vehicle crash 0.9%). Emergency anesthesiology care within 2 hours of arrival was delivered to 4.7% of injured patients (2124; 541 firearm [25.4%] and 1583 [74.5%] nonfirearm). Patients with firearm injuries were younger (30 [23-40] years vs 41 [29-56] years; P < .0001), male (90% vs 75%; P < .0001), direct admissions from scene (78% vs 62%; P < .0001), had less polytrauma (10% vs 22%; P < .0001), arrived after hours (73% vs 63%; P < .0001), and received earlier anesthesiology care (0.4 [0.3-0.7] vs 0.9 [0.5-1.5] hours after arrival; P < .0001). Patients with firearm injuries more often received invasive arterial (83% vs 77%; P < .0001) and central venous (14% vs 10%; P = .02) cannulation, blood products (3 [0-11] vs 0 [0-7] units; P < .0001), tranexamic acid (30% vs 22%; P < .001), as well as had higher estimated blood loss (500 [200-1588] mL vs 300 [100-1000] mL; P < .0001), and were transferred to the intensive care unit (ICU) more frequently (83% vs 77%; P < .001) than patients with nonfirearm injuries. Intraoperative mortality was comparable (6% firearm vs 4% nonfirearm) but postoperative mortality was lower for patients with firearm injuries who survived the intraoperative course (6% vs 14%; P < .0001). Comparatively, more patients with firearm injuries were discharged to home, or to jail (P < .001). CONCLUSIONS Over the study period, anesthesiologists increasingly cared for patients with firearm injuries, who often present outside of daytime hours and require urgent operative intervention. Operating room readiness and high-intensity resuscitation capacity, such as access to hemostatic control measures, are critical to achieving intraoperative survival and favorable postoperative outcomes, particularly for patients with firearm injuries.
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Affiliation(s)
- Andrew M Walters
- From the Department of Anesthesiology and Pain Medicine, Department of
| | - Pudkrong Aichholz
- From the Department of Anesthesiology and Pain Medicine, Department of
| | - Maeve Muldowney
- From the Department of Anesthesiology and Pain Medicine, Department of
| | - Wil Van Cleve
- From the Department of Anesthesiology and Pain Medicine, Department of
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Lynn G Stansbury
- From the Department of Anesthesiology and Pain Medicine, Department of
| | - Monica S Vavilala
- From the Department of Anesthesiology and Pain Medicine, Department of
- Department of Pediatrics, University of Washington, Seattle, Washington
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4
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Biffi A, Porcu G, Castellini G, Napoletano A, Coclite D, D'Angelo D, Fauci AJ, Iacorossi L, Latina R, Salomone K, Iannone P, Gianola S, Chiara O. Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review. Eur J Trauma Emerg Surg 2023; 49:1259-1270. [PMID: 36526811 PMCID: PMC10229449 DOI: 10.1007/s00068-022-02185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The effect of systemic hemostatic agents initiated during pre-hospital care of severely injured patients with ongoing bleeding or traumatic brain injury (TBI) remains controversial. A systematic review and meta-analysis was therefore conducted to assess the effectiveness and safety of systemic hemostatic agents as an adjunctive therapy in people with major trauma and hemorrhage or TBI in the context of developing the Italian National Institute of Health guidelines on major trauma integrated management. METHODS PubMed, Embase, and Cochrane Library databases were searched up to October 2021 for studies that investigated pre-hospital initiated treatment with systemic hemostatic agents. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach, and the quality of each study was determined with the Cochrane risk-of-bias tool. The primary outcome was overall mortality, and secondary outcomes included cause-specific mortality, health-related quality of life, any adverse effects and blood product use, hemorrhage expansion, and patient-reported outcomes. RESULTS Five trials of tranexamic acid (TXA) met the inclusion criteria for this meta-analysis. With a high certainty of evidence, when compared to placebo TXA reduced mortality at 24 h (relative risk = 0.83, 95% confidence interval = 0.73-0.94) and at 1 month among trauma patients (0.91, 0.85-0.97). These results depend on the subgroup of patients with significant hemorrhage because in the subgroup of TBI there are no difference between TXA and placebo. TXA also reduced bleeding death and multiple organ failure whereas no difference in health-related quality of life. CONCLUSION Balancing benefits and harms, TXA initiated in the pre-hospital setting can be used for patients experiencing major trauma with significant hemorrhage since it reduces the risk of mortality at 24 h and one month with no difference in terms of adverse effects when compared to placebo. Considering the subgroup of severe TBI, no difference in mortality rate was found at 24 h and one month. These results highlight the need to conduct future studies to investigate the role of other systemic hemostatic agents in the pre-hospital settings.
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Affiliation(s)
- Annalisa Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Gloria Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Antonello Napoletano
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Daniela Coclite
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Daniela D'Angelo
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Alice Josephine Fauci
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Laura Iacorossi
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Roberto Latina
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Katia Salomone
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Primiano Iannone
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Osvaldo Chiara
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milan, Italy
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5
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Lubkin DT, Van Gent JM, Cotton BA, Brill JB. Mortality and outcomes by blood group in trauma patients: A systematic review and meta-analysis. Vox Sang 2023. [PMID: 37045792 DOI: 10.1111/vox.13427] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Blood group O contains lower levels of factor VIII and von Willebrand factor. Higher incidence of bleeding among group O is reported in multiple contexts. Results of studies vary regarding outcomes stratified by blood group in trauma. We systematically reviewed the literature for outcomes related to blood group in trauma patients. Meta-analysis of studies evaluating mortality related to blood group was performed. MATERIALS AND METHODS The PubMed and Embase databases were searched for studies analysing relationships between blood group and outcomes in trauma patients. Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We synthesized outcomes data related to blood group. Meta-analysis compared mortality rates between group O and non-O patients. RESULTS Inclusion criteria were met by 13 studies. Statistically significant differences by blood group were reported in 3 of 10 (30%) studies evaluating mortality, 2 of 3 (66.7%) evaluating mortality from haemorrhage and 2 of 9 (22.2%) evaluating transfusion requirement. Meta-analysis was performed on seven studies evaluating mortality (total n = 11,835). There was significant heterogeneity among studies (I2 = 86%, p < 0.00001). No difference was found in mortality between group O and non-O patients (relative risk = 1.21, 95% confidence interval = 0.89-1.64, p = 0.23). CONCLUSION Existing literature does not consistently demonstrate a mortality difference between trauma patients with O and non-O blood groups. High variability in the methods and results among studies limits this conclusion, and further research is needed to delineate under what circumstances blood group may influence outcomes.
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Affiliation(s)
- David T Lubkin
- Department of General Surgery, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Jan-Michael Van Gent
- Department of General Surgery, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Bryan A Cotton
- Department of General Surgery, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Jason B Brill
- Department of General Surgery, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
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6
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Lewis RE, Muluk SL, Reitz KM, Guyette FX, Brown JB, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Yazer MH, Heidel RE, Rowe AS, Sperry JL, Daley BJ. Prehospital plasma is associated with survival principally in patients transferred from the scene of injury: A secondary analysis of the PAMPer trial. Surgery 2022; 172:1278-1284. [PMID: 35864051 PMCID: PMC9999176 DOI: 10.1016/j.surg.2022.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND We sought to characterize if prehospital transfer origin from the scene of injury (SCENE) or from a referral emergency department (REF) alters the survival benefit attributable to prehospital plasma resuscitation in patients at risk of hemorrhagic shock. METHODS We performed a secondary analysis of data from a recently completed prehospital plasma clinical trial. All of the enrolled patients from either the SCENE or REF groups were included. The demographics, injury characteristics, shock severity and resuscitation needs were compared. The primary outcome was a 30-day mortality. Kaplan-Meier analysis and Cox-hazard regression were used to characterize the independent survival benefits of prehospital plasma for transport origin groups. RESULTS Of the 501 enrolled patients, the REF group patients (n = 111) accounted for 22% with the remaining (n = 390) originating from the scene. The SCENE group patients had higher injury severity and were more likely intubated prehospital. The REF group patients had longer prehospital times and received greater prehospital crystalloid and blood products. Kaplan-Meier analysis revealed a significant 30-day survival benefit associated with prehospital plasma in the SCENE group (P < .01) with no difference found in the REF group patients (P = .36). The Cox-regression verified after controlling for relevant confounders that prehospital plasma was independently associated with a 30-day survival in the SCENE group patients (hazard ratio 0.59; 95% confidence interval 0.39-0.89; P = .01) with no significant relationship found in the REF group patients (hazard ratio 1.03, 95% confidence interval 0.4-3.0). CONCLUSION Important differences across the SCENE and REF cohorts exist that are essential to understand when planning prehospital studies. Prehospital plasma is associated with a survival benefit primarily in SCENE group patients. The results are exploratory but suggest transfer origin may be an important determinant of prehospital plasma benefit.
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Affiliation(s)
- Rachel E Lewis
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Sruthi L Muluk
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joshua B Brown
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Richard S Miller
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Jeffrey A Claridge
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern, Dallas, TX
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - A Shawn Rowe
- Department of Surgery, University of Tennessee Medical Center at Knoxville, Knoxville, TN
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
| | - Brian J Daley
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
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7
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Gebregiorgis HT, Hasan RA, Liu Z, Phuong J, Stansbury LG, Khan J, Tsang HC, Vavilala MS, Hess JR. Drivers of blood use in paediatric trauma: A retrospective cohort study. Transfus Med 2022; 32:383-393. [DOI: 10.1111/tme.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/29/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hermela T. Gebregiorgis
- Department of Anesthesiology and Pain Medicine Harborview Injury Prevention and Research Center, University of Washington (UW) School of Medicine (SOM) Seattle Washington USA
- University of Washington (UW) School of Pharmacy Seattle Washington USA
| | - Rida A. Hasan
- Department of Laboratory Medicine and Pathology UW School of Medicine (SOM) Seattle Washington USA
- Department of Pediatrics UW SOM Seattle Washington USA
| | - Zhinan Liu
- Department of Anesthesiology and Pain Medicine Harborview Injury Prevention and Research Center, University of Washington (UW) School of Medicine (SOM) Seattle Washington USA
| | - Jim Phuong
- Department of Anesthesiology and Pain Medicine Harborview Injury Prevention and Research Center, University of Washington (UW) School of Medicine (SOM) Seattle Washington USA
| | - Lynn G. Stansbury
- Department of Anesthesiology and Pain Medicine Harborview Injury Prevention and Research Center, University of Washington (UW) School of Medicine (SOM) Seattle Washington USA
- Department of Pediatrics UW SOM Seattle Washington USA
- Department of Anesthesiology and Pain Medicine UW SOM Seattle Washington USA
| | - Jenna Khan
- Department of Laboratory Medicine and Pathology UW School of Medicine (SOM) Seattle Washington USA
- Transfusion Medicine Service Dartmouth Hitchcock Medical Centre Hanover New Hampshire USA
| | - Hamilton C. Tsang
- Department of Laboratory Medicine and Pathology UW School of Medicine (SOM) Seattle Washington USA
| | - Monica S. Vavilala
- Department of Anesthesiology and Pain Medicine Harborview Injury Prevention and Research Center, University of Washington (UW) School of Medicine (SOM) Seattle Washington USA
- Department of Pediatrics UW SOM Seattle Washington USA
- Department of Anesthesiology and Pain Medicine UW SOM Seattle Washington USA
| | - John R. Hess
- Department of Anesthesiology and Pain Medicine Harborview Injury Prevention and Research Center, University of Washington (UW) School of Medicine (SOM) Seattle Washington USA
- Department of Laboratory Medicine and Pathology UW School of Medicine (SOM) Seattle Washington USA
- Transfusion Medicine Service Harborview Medical Centre Seattle Washington USA
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8
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Addams J, Arbabi S, Bulger EM, Stansbury LG, Tuott EE, Hess JR. How we built a hospital-based community whole blood program. Transfusion 2022; 62:1699-1705. [PMID: 35815552 DOI: 10.1111/trf.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whole blood (WB) is an attractive product for prehospital treatment of hemorrhagic shock and for initial in-hospital resuscitation of patients likely to require massive transfusion. Neither our regional blood provider nor our hospital blood bank had recent experience collecting or using WB, so we developed a stepwise process to gather experience with WB in clinical practice. METHODS When our Transfusion Committee suggested a WB program, we worked with our regional blood provider to collect cold-stored, leukoreduced, low-titer anti-A, and anti-B group O RhD positive WB (low-titer group O WB [LTOWB]) and worked with our city Fire Department to integrate it into prehospital care. This work required planning, development of protocols, writing software for blood bank and electronic medical records, changes in paramedic scope of practice, public information, training of clinicians, and close clinical follow-up. RESULTS Between June 2019 and December 2021, we received 2269 units of LTOWB and transfused 2220 units; 24 (1%) were wasted, two were withdrawn, and 23 were in stock at the end of that time. Most (89%) were transfused to trauma patients. Usage has grown from 48 to 120 units/month, covers all 5 Fire Districts in the county, and represents about ¼ of all hospital trauma blood product use. CONCLUSIONS Developing a WB program is complex but can be started slowly, including both pre-hospital and hospital elements, and expanded as resources and training progress. The investments of time, effort, and funding involved can potentially improve care, save blood bank and nursing effort, and reduce patient charges.
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Affiliation(s)
- Joel Addams
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Saman Arbabi
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.,Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington, USA.,Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA.,Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington, USA
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9
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Ali M, Liu Z, Taylor M, Orcutt T, Bledsoe A, Phuong J, Stansbury LG, Arbabi S, Robinson BRH, Bulger E, Vavilala MS, Hess JR. Blood product availability in the Washington state trauma system. Transfusion 2022; 62:1218-1229. [PMID: 35470898 DOI: 10.1111/trf.16888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/06/2022] [Accepted: 03/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Early transfusion can prolong life in injured patients awaiting definitive hemorrhage control. We conducted a community resources assessment of blood product availability at hospitals within the Washington State (WA) Regional Trauma System, with the expectation that a minority of Level IV and V centers would have blood products routinely available for use in resuscitation. METHODS We designed a questionnaire soliciting information on routinely available unit quantities of red blood cells (RBC), plasma, platelets, cryoprecipitate, and/or whole blood and submitted this questionnaire electronically to the 82 WA designated trauma centers (Levels I-V). Non-responders were contacted directly by telephone. The study was conducted in September and October 2021. US 2020 census data were used to correlate results with local population densities. RESULTS First-round contact netted responses from 57 (70%) centers; the remaining centers provided information via telephone, for a 100% final response. Packed RBC were available in 79 of the 82 centers (96%; range 6-220 units); plasma, 62 centers (76%, range 1-100 units); platelets, 40 centers (49%, range 1-8 units); cryoprecipitate, 45 centers (55%, range 1-20 units). Whole blood was only available at the Level I center. Three Level V centers, located in 2 of the 8 WA state trauma regions, reported no routine blood availability. The two trauma regions affected represent 12% of the state's population and more than a third of its geographic area. CONCLUSIONS Within the WA regional trauma system, blood products are wide, if unevenly, available. Large urban/rural disparities in availability exist that should be explored.
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Affiliation(s)
- Mohamed Ali
- Department of Laboratory Medicine and Pathology, UW School of Medicine (SOM), Seattle, WA, USA
| | - Zhinan Liu
- Harborview Injury Prevention and Research Center (HIPRC), UW SOM, Seattle, WA, USA
| | - Mark Taylor
- Harborview Trauma Program, Harborview Medical Center (HMC), Seattle, WA, USA.,Office of Community Health, Emergency Care Systems, Washington State Department of Health, Olympia, WA, USA
| | - Tim Orcutt
- Office of Community Health, Emergency Care Systems, Washington State Department of Health, Olympia, WA, USA
| | - Anthony Bledsoe
- Office of Community Health, Emergency Care Systems, Washington State Department of Health, Olympia, WA, USA
| | - Jimmy Phuong
- Harborview Injury Prevention and Research Center (HIPRC), UW SOM, Seattle, WA, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center (HIPRC), UW SOM, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, UW SOM, Seattle, Washington, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center (HIPRC), UW SOM, Seattle, WA, USA.,Department of Surgery, UW SOM, Seattle, Washington, USA
| | - Bryce R H Robinson
- Office of Community Health, Emergency Care Systems, Washington State Department of Health, Olympia, WA, USA.,Department of Surgery, UW SOM, Seattle, Washington, USA
| | - Eileen Bulger
- Department of Surgery, UW SOM, Seattle, Washington, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center (HIPRC), UW SOM, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, UW SOM, Seattle, Washington, USA.,Department of Pediatrics, UW SOM, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, UW School of Medicine (SOM), Seattle, WA, USA.,Harborview Injury Prevention and Research Center (HIPRC), UW SOM, Seattle, WA, USA.,Transfusion Services, Harborview Medical Center (HMC), Seattle, Washington, USA
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