Cost Savings of Whole Blood Versus Component Therapy at a Community Level 1 Trauma Center.

BACKGROUND: Blood product component-only resuscitation (CORe) has been the standard of practice in both military and civilian trauma care with a 1:1:1 ratio used in attempt to recreate whole blood (WB) until recent data demonstrated WB to confer a survival advantage, leading to the emergence of WB as the contemporary resuscitation strategy of choice. Little is known about the cost and waste reduction associated with WB vs CORe. METHODS: This study is a retrospective single-center review of adult trauma patients admitted to a community trauma center who received WB or CORe as part of their massive transfusion protocol (MTP) resuscitation from 2017 to 2021. The WB group received a minimum of one unit WB while CORe received no WB. Univariate and multivariate analyses were completed. Statistical analysis was conducted using a 95% confidence level. Non-normally distributed, continuous data were analyzed using the Wilcoxon rank sum test. RESULTS: 576 patients were included (201 in WB and 375 in CORe). Whole blood conveyed a survival benefit vs CORe (OR 1.49 P < .05, 1.02-2.17). Whole blood use resulted in an overall reduction in products prepared (25.8%), volumes transfused (16.5%), product waste (38.7%), and MTP activation (56.3%). Cost savings were $849 923 annually and $3 399 693 over the study period. DISCUSSION: Despite increased patient volumes over the study period (43.7%), the utilization of WB as compared to CORe resulted in an overall $3.39 million cost savings while improving mortality. As such, we propose WB should be utilized in all resuscitation strategies for the exsanguinating trauma patient.

Is emergent anti-hypertensive treatment beneficial in intracranial hemorrhage?

A retrospective chart review of adult patients with primary intracranial hemorrhage (ICH) was conducted to determine the effects of emergent anti-hypertensives on mortality. Data included mean arterial pressure (MAP), Glascow Coma Scale score (GCS), ICH size, and anti-hypertensive treatment. Multi-variable logistic regression determined the effect of anti-hypertensives on ICH mortality. Of 66 patients studied, the overall mortality was 30.3%. Mortality was 34.5% for patients initially treated with anti-hypertensives vs. 25.8% for patients not treated. After controlling for age, MAP, GCS, and ICH size, anti-hypertensives given within the first 6 h of presentation were associated with a reduction in mortality with a p value of 0.0375 and an odds ratio of 140 (95% confidence interval [CI] 1.332 to >999). However, this effect may not occur in patients presenting with a systolic blood pressure (SBP)<200 mm Hg. In conclusion, in patients with primary intracranial hemorrhage, there was a significant decrease in mortality associated with emergent anti-hypertensive therapy. A larger prospective study is needed to confirm these findings, define the subgroups that may benefit, and better determine the effect size.