Transfusion Approach Reduces Death from Blood Loss

A new study shows that a blood transfusion with equal ratios of plasma, platelets, and red blood cells (RBCs) give patients a significantly better chance of survival.

Researchers at the University of Maryland (College Park, USA), the University of Texas Health Science Center (Houston, USA), and other institutions conducted a study involving 680 severely injured patients who received treatment at one of 12 Level I trauma centers across the United States. The patients were randomly assigned to receive one of the two transfusion protocols. Damage control resuscitation (DCR) gave patients equal ratios of plasma, platelets, and RBCs (1:1:1); the other gave patients a ratio that had equal numbers of plasma and platelets, but twice as many RBCs (1:1:2).

The results showed that exsanguination within the first 24 hours of trauma was significantly decreased in the DCR group (9.2%), compared to the 1:1:2 group (14.6%). Additionally, more patients in the DCR group achieved hemostasis than in the 1:1:2 group (86% versus 78%); the two groups had the same overall survival at 30 days. The study also compared 23 complications and found no significant differences between the two blood transfusion protocols. The study was published on February 3, 2015, in the Journal of the American Medical Association (JAMA).

“Bleeding to death is the leading, potentially preventable cause of death in military and civilian trauma patients. If I needed a massive blood transfusion, I would want damage control resuscitation,” said lead author John Holcomb, MD, a retired US Army surgeon and director of the division of acute care surgery at UTH. “This idea started on the battlefield, and it was translated into the civilian world. Now we’ve done a high-quality study to make sure that our observations on the battlefield hold true.”

“Doctors had gone with the earlier blood formula out of concerns that recipes containing more plasma or platelets would increase a patient's risk of harmful blood clots, organ failure, blood infection, or decreased red blood cell counts,” commented Robert Glatter, MD, spokesman of the American College of Emergency Physicians (Irving, TX, USA). “Despite that, it was clear from the study that more patients in the 1:1:1 group had their bleeding controlled sooner, with fewer dying from massive blood loss at 24 hours.”

DCR was first developed by US military trauma surgeons treating soldiers injured in the Afghanistan and Iraq Wars, and refers to guidelines for combat casualties developed by a multidisciplinary team that included Dr. Holcomb, who was an Army Colonel at the time. It is now used by most military and civilian hospitals throughout the United States.

Related Links:
University of Maryland
University of Texas Health Science Center
American College of Emergency Physicians