ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Whole blood first resuscitation and association of blood product utilization based on mechanism of injury.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionStudies evaluating the effect of whole blood (WB) vs. component-based resuscitation accounting for mechanism of injury are lacking. We sought to evaluate the effects of a WB first resuscitation strategy regarding mechanism of injury.
methodsThis is a retrospective cohort study of trauma patients who received any blood product during resuscitation from January 2016 to November 2021. The primary outcomes were total blood volume utilized within 24 h and 30-day mortality. Multivariable gamma regression with a log link was used for blood volume and logistic regression for mortality. A likelihood ratio test evaluated whether injury mechanism modified the treatment effect.
resultsBetween January 2016 and November 2021, 1,013 injured patients received blood products (785 WB-first). We did not detect statistically significant effect modification by injury mechanism for either outcome (interaction p = 0.44 for blood volume, p = 0.25 for mortality). In multivariable gamma regression, WB-first resuscitation was associated with a ratio of mean total blood volume of 0.71 (95% CI 0.55 to 0.90, p = 0.005) relative to components, representing approximately 29% lower utilization. WB-first was not associated with 30-day mortality (OR 0.90, 95% CI 0.48 to 1.71, p = 0.73).
conclusionsA WB-first resuscitation strategy is associated with lower blood volume utilized within the first 24 h, without statistically significant effect modification by injury mechanism (though clinically meaningful mechanism-specific differences cannot be excluded). The mortality estimate was non-significant across all analytic approaches but varied in direction (OR 0.66 to 1.48) and was sensitive to handling of approximately 30% of patients with incomplete laboratory data. Further studies are needed to determine which populations most benefit from WB-based resuscitation.
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