(1750) Whole Blood Transfusion Decreases Length of Stay in Trauma Patients

Introduction: Current trauma management guidelines champion the idea of a balanced resuscitation, including a 1:1:1 transfusion practice of packed red blood cells, pooled platelets, fresh frozen plasma, and cryoprecipitate. Component therapy like this allows tailoring resuscitation to a specific patient’s needs, but the volume of product transfused can be significant, causing fluid overload. Renewed interest in whole blood transfusion, prompted by newer data from the military and duplicated subsequently in civilian sectors, has challenged the current balanced resuscitation protocol. Still in its infancy, the practice of whole blood transfusion in the civilian setting requires further outcomes data and justification for its utilization over standard balanced resuscitation. One such justification could include a cost benefit – at our institution, whole blood (WB) costs $0.93/mL, in contrast to $1.60/mL of packed red blood cells (RBC). To investigate the clinical and financial downstream effects of adding WB transfusions to a trauma resuscitation, we performed a retrospective cohort study at a level 1 trauma center.

Methods: The transfusion history at an urban level 1 trauma center from 2020 to 2023 was recorded. The amount of WB and RBC transfused were recorded. Outcomes data including length of stay and mortality were collected and subgroups of recipients of mass transfusion protocol (MTP) were analyzed.

Results: Over three years, the rate of RBC vs. WB transfusion changed dramatically. Initially, there was no whole blood transfused, but over the subsequent years, the rate of WB transfusion rose to 47% by the end of 2023. The total number of transfusions overall stayed largely stable, ranging from 63 to 86 units.
The total average volume of blood product transfused was lower if patients received WB (1405 vs. 967 mL, p = 0.04). The length of stay for patients receiving WB was lower by 3.2 days (6.8 vs. 10 days, p = 0.03). If the patient received MTP and WB as part of the resuscitation, that difference was even more dramatic (6.5 vs. 16.3 days, p = 0.04).

Conclusions: Incorporating whole blood transfusion into trauma resuscitation yields a shorter length of stay and decreased volume of transfused product, with marked findings if the patient received MTP.