Warm Fresh Whole Blood is Independently Associated with Improved Survival for Patients with Combat-Related Traumatic Injuries

## Philip C. Spinella, MD, Jeremy G. Perkins, MD, Kurt W. Grathwohl, MD, Alec C. Beekley, MD, and John B. Holcomb, MD

The Journal of TRAUMA Injury, Infection, and Critical Care

J Trauma. 2009;66:S69 ?S76.

#### Description and Key Points:

The authors of this article examined the possibility that warm fresh whole blood (WFWB) transfusion would be associated with improved survival in patients with traumatic injuries compared with those transfused only stored component therapy (CT). They retrospectively looked at US Military combat casualty patients transfused >1 unit of red blood cells (RBCs), and compared two groups of patients:

1. WFWB, who were transfused WFWB, RBCs, and plasma but not apheresis platelets
2. CT, who were transfused RBC, plasma, and apheresis platelets but not WFWB.

The primary outcomes measured were 24-hour and 30-day survival. Of 354 patients analyzed there were 100 in the WFWB and 254 in the CT group. Patients in both groups had similar severity of injury.

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- Both 24-hour and 30-day survival were higher in the WFWB cohort compared with CT patients.
- An increased amount (825 mL) of additives and anticoagulants were administered to the CT compared with the WFWB group.
- Upon further statistical analysis, the use of WFWB and the volume of WFWB transfused was independently associated with improved 30-day survival.
- In a subset analysis, the data indicated that as time progressed and capabilities improved at combat support hospitals that the relationship between improved survival and WFWB use remained and was not influenced by this factor.

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# Take Home Message:

A 13% increase in 30-day survival was measured with the use of WFWB in combat casualties transfused one or more units of RBCs compared with the Component Therapy group.
In patients with hemorrhagic shock due to trauma, resuscitation strategies that include Warm Fresh Whole Blood may improve 30-day survival. This may be a result of less anticoagulants, additives, and volume used with WFWB.