Journal Review in Trauma Surgery: Blood Transfusions
Feb 9, 2023
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Exploration of the history of blood transfusions, the survival advantage of whole blood transfusions in trauma patients, and the incorporation of whole blood transfusion in standard medical procedures. Advanced techniques like Rotem and Teg for guiding resuscitation, importance of blood products in trauma care, and comparison of use in military and civilian settings.
Whole blood transfusion improves survival in severe hemorrhage trauma patients.
Balanced resuscitation with blood components and targeted therapy enhances trauma patient outcomes.
Deep dives
History of Blood Transfusions
The podcast delves into the history of blood transfusions, starting with early claims of transfusions in the Incan Empire, moving through experiments in France and England with animal-to-human transfusions in the 1600s, and the discovery of blood groups in the early 1900s by Karl Landsteiner and subsequent advancements in intraoperative transfusions and the development of blood banks.
Whole Blood in Civilian Trauma Centers
The episode highlights a research paper published in JAMA Surgery investigating the Association of Whole Blood with Survival in US and Canadian civilian trauma centers. The study explores the benefits of whole blood transfusion in patients with severe hemorrhage, comparing outcomes between whole blood and massive transfusion protocols across a two-year period from 2017 to 2018. The findings suggest that whole blood transfusion was associated with improved survival at 24 hours and 30 days without a significant increase in complications.
Integration of Whole Blood Resuscitation
The discussion extends to the implementation and integration of whole blood resuscitation in trauma care, including the experiences and protocols at institutions like Johns Hopkins Hospital. The episode emphasizes the shift towards balanced resuscitation with packed red blood cells, platelets, and plasma, as well as the importance of damage control resuscitation principles. It also explores the role of comprehensive lab testing and pharmacologic agents like tranexamic acid in guiding targeted resuscitation and improving outcomes in trauma patients.
In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward
Hosts:
Elliott R. Haut, MD, PhD, a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST) and editor-in-chief of Trauma Surgery and Acute Care Open.
Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.
LITERATURE
Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023. https://pubmed.ncbi.nlm.nih.gov/36652255/
Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326. https://pubmed.ncbi.nlm.nih.gov/30044935/
Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291. https://pubmed.ncbi.nlm.nih.gov/30032977/
Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):605-617. https://pubmed.ncbi.nlm.nih.gov/28225743/
Howley IW, Haut ER, Jacobs L, Morrison JJ, Scalea TM. Is thromboelastography (Teg)-based resuscitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3(1):e000140. https://pubmed.ncbi.nlm.nih.gov/29766129/
Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020;156(1):11-20. https://pubmed.ncbi.nlm.nih.gov/33016996/
Smart BJ, Haring RS, Zogg CK, et al. A faculty-student mentoring program to enhance collaboration in public health research in surgery. JAMA Surg. 2017;152(3):306-308. https://pubmed.ncbi.nlm.nih.gov/27973649/
Braverman MA, Smith A, Pokorny D, et al. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion. 2021;61 Suppl 1:S15-S21. https://pubmed.ncbi.nlm.nih.gov/34269467/