Table 1.
Studies of WB in the Civilian Population.
| Study | Number of Patients Receiving WB | Study Design | Description | Results |
|---|---|---|---|---|
| Cotton et al. [28] | 55 | RCT | Single-center, RCT comparing modified WB and component therapy | No difference in 30 day mortality. Possible transfusion benefit in TBI. |
| Williams et al. [33] | 198 | Comparative clinical prospective therapeutic study | Comparison of LTOWB versus BCT in prehospital and ED setting for trauma patients | LTOWB received less post-ED blood products with equivocally mortality benefit. |
| Hanna et al. [36] | 280 | Retrospective cohort analysis | Analysis of 2015–2016 ACS TQIP database comparing patients in hemorrhagic shock and given at least one unit of PRBCs or WB (note this likely includes patients from other studies) | WB associated with improved 24 h mortality overall and improved in-hospital mortality in subgroups with penetrating mechanism and those without severe head injury. |
| Ho and Leonard [31] | 77 | Retrospective cohort study | Unrefrigerated young WB transfusion for patients requiring massive transfusion in a civilian setting | No benefit (overall survival and transfusion were equivalent) |
| Leeper et al. [38] | 28 | Propensity matched cohort | Propensity matched cohort of children over 1 year | No difference in mortality. Improved indices of shock and coagulopathy. |
| Seheult et al. [22] | 172 | Retrospective case–control analysis | Safety analysis of LTOWB patients by blood group | No mortality difference, similar clinical outcomes across groups, no increased hemolysis noted at 24 h in nongroup O patients. |
| Fadeyi et al. [35] | 167 | Retrospective cohort | Comparison trauma patient receiving LTOWB with leuko-reduced LTOWB | Nonstatistically significant 6% increased mortality in leuko-reduced LTOWB (p = 0.185). |
| Hazelton et al. [30] | 107 | Dual-center case-match study | Matching analysis for patients who received CSWB vs. BCT for hemodynamic parameters, hemoglobin and hematocrit at 24 h, trauma bay mortality, and 30 day mortality | CSWB associated with improved trauma bay survival and higher mean hemoglobin value at 24 h. No difference in the amount of blood products transfused at 4 and 24 h periods.No difference in 30 day mortality between the two groups. |
| Shea et al. [37] | 44 | Prospective observational | Before-and-after comparison of trauma patient requiring activation of massive transfusion before and after implementation of LTOWB MTP (up to 8 LTOWB unit) | No difference of absolute mortality between groups. Post-hoc multivariate regression showed improved adjusted mortality in LTOWB group. Authors argue for effect mediation based on ROTEM parameters. |
| Gallaher et al. [29] | 42 | Retrospective observational | Before-and-after comparison of mortality in trauma patients receiving blood products during implementation of LTOWB program | LTOWB did not alter 30 day mortality, nonstatistically significant increase in total blood products, and no difference in lab values at 48 h. |
| Zielinski et al. [2] | 24 Mayo 22 Pittsburgh 73 Royal Caribbean |
Retrospective observational | Describes the THOR network prehospital WB programs including Mayo Clinic and Allegheny General Hospital and WFWB transfusion on Royal Caribbean cruise | Observation only. Overall mortality in patients who received WB 31%. |
| Seheult et al. [25] | 44 | Observational study | Hemolysis markers in group O and nongroup O recipients of platelet replete, uncrossmatched CSWB | No difference in hemolysis markers across groups. |
| Zhu et al. [19] | 30 | Retrospective observational | Descriptive study of prehospital WB transfusion implementation which included transfusion of 25 adults and 5 pediatric patients | Observational. Mortality in adult: 36%; mean ISS: 29. Mortality in pediatric: 20%; mean ISS: 29. Mean transport time, 37 min. |
| Leeper et al. [20] | 18 | Retrospective observational | Pediatric uncrossmatched LTOWB transfusion for hemorrhagic shock | ISS: 34. Mortality 44%. |
| Condron et al. [27] | 1 | Case report | Case report of massive transfusion using 38 units of LTOWB in addition to MTP with blood components | N/A |
Abbreviations: ACS, American College of Surgeons; BCT, blood component therapy; CSWB, cold-stored whole blood; ED, emergency department; ISS, injury severity score; LTOWB, low-titer group O whole blood; MTP, massive transfusion protocol; PRBCs, packed red blood cells; RCT, randomized controlled trial; ROTEM, rotational thromboelastometry; TBI, traumatic brain injury; THOR, Trauma Hemostasis and Oxygenation Research; TQIP, Trauma Quality Improvement Program; WB, whole blood; WFWB, warm fresh whole blood.