ImportanceCivilian trauma centers have revived interest in whole-blood (WB) resuscitation for patients with life-threatening bleeding. However, there remains insufficient evidence that the timing of WB transfusion when given as an adjunct to a massive transfusion protocol (MTP) is associated with a difference in patient survival outcome.ObjectiveTo evaluate whether earlier timing of first WB transfusion is associated with improved survival at 24 hours and 30 days for adult trauma patients presenting with severe hemorrhage.Design, Setting, and ParticipantsThis retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program databank from January 1, 2019, to December 31, 2020, for adult patients presenting to US and Canadian adult civilian level 1 and 2 trauma centers with systolic blood pressure less than 90 mm Hg, with shock index greater than 1, and requiring MTP who received a WB transfusion within the first 24 hours of emergency department (ED) arrival. Patients with burns, prehospital cardiac arrest, deaths within 1 hour of ED arrival, and interfacility transfers were excluded. Data were analyzed from January 3 to October 2, 2023.ExposurePatients who received WB as an adjunct to MTP (earlier) compared with patients who had yet to receive WB as part of MTP (later) at any given time point within 24 hours of ED arrival.Main Outcomes and MeasuresPrimary outcomes were survival at 24 hours and 30 days.ResultsA total of 1394 patients met the inclusion criteria (1155 male [83%]; median age, 39 years [IQR, 25-51 years]). The study cohort included profoundly injured patients (median Injury Severity Score, 27 [IQR, 17-35]). A survival curve demonstrated a difference in survival within 1 hour of ED presentation and WB transfusion. Whole blood transfusion as an adjunct to MTP given earlier compared with later at each time point was associated with improved survival at 24 hours (adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P = .003). Similarly, the survival benefit of earlier WB transfusion remained present at 30 days (adjusted hazard ratio, 0.32; 95% CI, 0.22-0.45; P < .001).Conclusions and RelevanceIn this cohort study, receipt of a WB transfusion earlier at any time point within the first 24 hours of ED arrival was associated with improved survival in patients presenting with severe hemorrhage. The survival benefit was noted shortly after transfusion. The findings of this study are clinically important as the earlier timing of WB administration may offer a survival advantage in actively hemorrhaging patients requiring MTP.

中文翻译：

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创伤患者严重失血后首次全血输注的时机和存活率

重要性民间创伤中心重新燃起了对危及生命的出血患者进行全血 (WB) 复苏的兴趣。然而，仍然没有足够的证据表明，作为大量输血方案 (MTP) 的辅助手段进行 WB 输血的时间与患者生存结果的差异相关。 目的 评估首次 WB 输血的较早时间是否与改善生存相关对于出现严重出血的成年创伤患者，分别进行 24 小时和 30 天。设计、设置和参与者这项回顾性队列研究使用了美国外科医生学会创伤质量改进计划数据库，从 2019 年 1 月 1 日到 2020 年 12 月 31 日，针对出现严重出血的成年患者前往美国和加拿大成人平民 1 级和 2 级创伤中心的收缩压低于 90 毫米汞柱、休克指数大于 1 且需要在急诊科 (ED) 到达后 24 小时内接受 WB 输血的 MTP。烧伤、院前心脏骤停、急诊到达后 1 小时内死亡以及跨机构转运的患者被排除在外。数据分析时间为 2023 年 1 月 3 日至 10 月 2 日。 暴露：在 ED 24 小时内的任何给定时间点，接受 WB 作为 MTP 辅助治疗（较早）的患者与尚未接受 WB 作为 MTP 一部分（较晚）的患者进行比较主要结果和措施主要结果是24小时和30天的生存率。结果共有1394名患者符合纳入标准（1155名男性[83%]；中位年龄39岁[IQR，25-51岁]）。研究队列包括严重受伤的患者（中位损伤严重程度评分，27 [IQR，17-35]）。生存曲线显示 ED 就诊和 WB 输血后 1 小时内的生存率存在差异。与在每个时间点较晚给予全血输血作为 MTP 的辅助相比，与 24 小时生存率的改善相关（调整后的风险比，0.40；95% CI，0.22-0.73；磷=.003）。同样，早期 WB 输血的生存获益在 30 天时仍然存在（调整后的风险比，0.32；95% CI，0.22-0.45；磷< .001).结论和相关性在这项队列研究中，在到达急诊室的前 24 小时内的任何时间点较早接受 WB 输血与严重出血患者生存率的改善相关。输血后不久就注意到了生存获益。这项研究的结果具有重要的临床意义，因为较早的 WB 给药时机可能为需要 MTP 的活动性出血患者提供生存优势。