Cold whole blood transfusion in civilian trauma patients requiring emergent resuscitation: a retrospective cohort study

Abstract Background: The use of cold whole blood (WB) is rapidly resurging as one of the treatment modalities of choice for the initial resuscitation of civilian trauma patients across the United States. The purpose of our study was to evaluate the effectiveness and safety of cold whole blood (WB) as compared to blood component therapy (BCT) in resuscitation of civilian trauma patients. Methods: This was a retrospective cohort study of trauma patients who received at least one unit of WB transfusion during emergent resuscitation between November 2015 and October 2019 at a level I trauma center. Primary outcome was mortality up to 30 days after trauma. Secondary outcomes included overall blood product utilization and incidence of transfusion reactions. Outcomes were compared between patients who received WB and a cohort receiving BCT who did not receive WB matched for age, sex, mechanism of injury, heart rate, systolic blood pressure, Glasgow Coma Scale, injury severity score, and FAST results. Results: We included 78 patients who received WB transfusion and 78 matched controls. Within 30 days of injury, there were 19 deaths (24.4%) in the WB cohort and 28 (35.9%) deaths in controls (hazard ratio 0.62, 95% CI 0.33 to 1.15, p = 0.086). Patients in the WB cohort received as many units of blood products as controls (median number of units was 10 (IQR 6, 20) vs. 12 (IQR 6, 23), p = 0.43). The incidence of any transfusion reactions was similar between groups (7.7% in WB vs 9.0% in controls, p = 0.78). Life-threatening reactions did not occur in any of the groups. Conclusions: There was no mortality difference between patients receiving cold WB and BCT. Cold WB was safe in this cohort with no life-threatening transfusion reactions.