The University of Maryland School of Medicine is part of a multi-site study in the US that may help save hundreds of lives among trauma patients with major bleeding. The study compared two different methods of blood transfusion, and found that one approach gave patients a significantly better chance of survival within the first 24 hours.
"This study is an important milestone in trauma care," said Dr Thomas M Scalea, who is the Francis X Kelly distinguished professor of trauma surgery as well as physician-in-chief of the R Adams Cowley Shock Trauma Centre at the University of Maryland Medical Centre. Scalea, who oversaw the school's participation in the study, was part of the committee that designed and oversaw the study. The centre enrolled approximately 40 patients. "These results will allow doctors to provide better, more effective care for trauma patients, whose lives often hang in the balance."
The study compared two transfusion techniques: One gave patients equal ratios of plasma, platelets, and red blood cells; the other gave patients a ratio that had equal numbers of plasma and platelets, but twice as many red blood cells and was led by Dr John B Holcomb, of the University of Texas Health Science Centre in Houston.
The research, which began in 2012, included 680 severely injured patients who received treatment at one of 12 Level I trauma centres around the US, including the Shock Trauma Centre in Baltimore. The patients were randomly assigned to receive one of the two transfusion mixtures during their treatment.
The study found that subjects in the equal-ratio group were more likely to stop bleeding, and had a better chance of surviving, in the first 24 hours, compared to patients in the other group. The two groups had the same overall level of survival at 30 days.
Death from loss of blood within the first 24 hours is a common cause of mortality for such patients. This cause of death significantly decreased in the equal-ratio group: 9.2%, compared with 14.6% in unequal-ratio group. In addition, bleeding stopped in 86% of patients in the equal-ratio group, compared with 78% in the unequal-ratio group. Loss of blood plays a key role in 20% to 40% of trauma deaths that occur after the patient is at the hospital. It may be possible to avoid some of these deaths with equal-ratio transfusion.
Some researchers have expressed concern that the equal-measure blood would cause increased inflammation, and might lead to problems such as organ failure, infection and blood clots. However, the study found no evidence that equal-ratio patients had any more inflammation-related problems. Overall, the study looked at 23 complications that can occur with transfusion and found that the risks of the two approaches were not significantly different.
In the article, Holcomb and the other authors recommend that healthcare providers should consider using the equal-ratio blood when giving transfusions to trauma patients.
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