Whole blood use in patients with traumatic brain injury and hemorrhagic shock is not associated with decreased mortality

BACKGROUND Traumatic brain injury (TBI) is a leading cause of trauma mortality worldwide. Whole blood (WB) is associated with decreased mortality compared with blood component therapy (BCT) alone in trauma patients with hemorrhagic shock (HS). The ideal resuscitation approach in patients with both TBI and HS remains unclear. We hypothesize that resuscitation with WB in trauma patients with TBI and HS improves mortality. METHODS Using a prospective, multicenter, observational database, we examined a subset of patients with TBI and HS. We compared patients receiving BCT only for resuscitation with those receiving WB with BCT. We used χ² and Kruskal-Wallis tests to compare categorical and continuous variables by the use of WB. We conducted a multivariable logistic regression to examine the association between WB and mortality controlling for shock index, Injury Severity Score, age, sex, comorbid conditions, serious head injury, and mechanism of injury. RESULTS A total of 535 patients were included. One hundred thirty-five patients received BCT, and 400 patients received WB with BCT. There were no differences in the median Injury Severity Score, age, presence of comorbid conditions, proportion of serious head injury, or total component transfusions in the first 24 hours of admission (p > 0.05). More patients in the WB group were male, in shock, and experienced blunt trauma (p < 0.05). On multivariable logistic regression, WB use was not independently associated with lower mortality (odds ratio, 1.06; [95% confidence interval, 0.65-1.75]; p=0.809). CONCLUSION We identified no in-hospital mortality benefit of WB transfusion in addition to BCT in trauma patients with TBI and HS. Further research is needed into optimal resuscitation strategies for these patients.