OBJECTIVES: To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients.
DATA SOURCES: A systematic search of PubMed, CINAHL, and Web of Science was performed from their inception through December 1, 2023. Key terms included injury, hemorrhage, bleeding, blood transfusion, and whole blood.
STUDY SELECTION: All studies comparing outcomes in injured civilian adults and children who received LTOWB versus CT were included.
DATA EXTRACTION: Data including author, publication year, sample size, total blood volumes, and clinical outcomes were extracted from each article and reported following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Main outcomes were 24-hour (early) and combined 28-day, 30-day, and in-hospital (late) mortality rates between recipients of LTOWB versus CT, which were pooled using random-effects models.
DATA SYNTHESIS: Of 1297 studies reviewed, 24 were appropriate for analysis. Total subjects numbered 58,717 of whom 5,164 received LTOWB. Eleven studies included adults-only, seven included both adults and adolescents, and six only included children. The median (interquartile range) age for patients who received LTOWB and CT was 35 years (24-39) and 35.5 years (23-39), respectively. Overall, 14 studies reported early mortality and 22 studies reported late mortality. LTOWB was associated with improved 24-hour survival (risk ratios [RRs] [95% CI] = 1.07 [1.03-1.12]) and late (RR [95% CI] = 1.05 [1.01-1.09]) survival compared with component therapy. There was no evidence of small study bias and all studies were graded as a moderate level of bias.
CONCLUSIONS: These data suggest hemostatic resuscitation with LTOWB compared with CT improves early and late survival outcomes in bleeding civilian trauma patients. The majority of subjects were injured adults; multicenter randomized controlled studies in injured adults and children are underway to confirm these findings.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This meta-analysis compared low-titer group O whole blood (LTOWB) with component therapy (CT) for bleeding civilian children and adults with traumatic injury. In the 24 observational studies that included 58,717 patients, LTOWB was associated with improved 24-hour (risk ratio [RR] [95% CI] = 1.07 [1.03–1.12]) and late (28-d, 30-d, in-hospital) survival (RR [95% CI] = 1.05 [1.01–1.09]) compared with component therapy. Although the results seem to favor LTOWB over CT, the odds radios are close to one and the authors do not provide the actual size of the risk benefit (e.g., in terms of absolute risk reduction). Furthermore, the studies were all observational studies, so firm conclusions may have to await RCTs.
Physician rater
Interesting study but not sure will be applicable to pediatric patients.
Physician rater
While this systematic review of observational studies showed a statistically significant benefit of low-titre group O whole blood compared with component therapy in civilian populations, the applicability to a general pediatric population is limited due to lack of availability, low frequency of use except in large trauma centres, and the fact that many of the patients would be females of childbearing potential, who were excluded from many of these studies. (This paper also had a painful amount of acronyms to keep track of.)
, McMaster University