(P-TS-49) Evolving patterns of initial blood product use in the era of hemorrhage control resuscitation.

Since the initial call for hemostatic resuscitation of trauma patients in 2007, there has been an evolving sense of how to best achieve this goal. We reviewed all trauma blood use for about 12 years, from our participation in the PROPPR trial to our early use of whole blood, to assess these changing patterns in the face of an ongoing “give plasma first” campaign.

Study

Design/Methods:

We conducted a retrospective cohort study of initial blood product used in all acute primary trauma patients arriving at our large US regional Level 1 trauma center from 6 April 2011 to 31 December 2022. Patients were identified through the Center's Trauma Registry and linked with Transfusion Service Laboratory final product issue records to identify those patients receiving any blood products within the first 24 hours of care in our system (including transport by our associated air and ground ambulance systems). Patients were included if they received at least one unit of Red Blood Cells (RBC), Plasma, or Whole Blood (WB). Results were binned as: "RBC first," "Plasma first," "Both at the same time," or "Whole Blood first." "Both at the same time" typically means a unit of plasma and a unit of RBCs issued at the same time, with the plasma given first as part of the "give plasma first" campaign. Statistics were limited to Chi-Square for trend (Cochrane-Armitage) analysis. Graphs were developed using R.

Results/Findings:

Over the study period, 69,454 trauma patients were seen, and 12,979 received any blood product. The proportion of patients receiving plasma or a combination of plasma and RBCs as the initial transfusion increased after the 2015 PROPPR study from 35 to 65%, while the proportion receiving packed RBCs alone decreased from 55% to about 15% as the use of whole blood as the first product has grown to 20% since 2019. (Figure 1).

Conclusions:

The increasing use of plasma and now whole blood as the initial product issued in trauma resuscitation marks a secular trend in better hemostatic resuscitation, which we believe has both clinical and blood bank inventory benefits.