K. Bush1, L. Shea2, J. San Roman2, E. Pailloz3, J. Gaughan4, A. Goldenberg-Sandau2 1Cooper Medical School of Rowan University,Camden, NJ, USA 2Cooper University Hospital,Department Of Surgery,Camden, NJ, USA 3Cooper University Hospital,Department Of Pathology,Camden, NJ, USA 4Cooper University Hospital,Cooper Research Institute,Camden, NJ, USA
Introduction:
Whole blood has gained popularity as a means of trauma resuscitation within the past 5 years. Historically the military has utilized whole blood since World War I and most recently during the wars in Afghanistan and Iraq. However, its overall use has diminished due to technological advances in blood component fractionation as well as fears of hemolysis and infectious disease transmission. Although there are studies and review articles on the efficacy of whole blood, the analysis of cost pertaining to whole blood’s expense is limited.
Methods:
We performed a retrospective 1:1 case control study of 280 subjects comparing trauma patients receiving resuscitation with blood component therapy to those receiving whole blood plus component therapy between January 2014 and July 2019. Patient matching was completed based on age, sex, injury severity score (ISS), and mechanism of injury (MOI) (blunt vs. penetrating). Endpoints included the number of units of whole blood (WB), packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate each patient received. Data analysis utilized ratios of price for each unit where PRBCs=1, WB=1.24, FFP=0.2, platelets=2.27, and cryoprecipitate=1.21. Due to proprietary nature of the cost of individual blood components, absolute price numbers are not included here. Comparisons were made with Wilcoxon two sample ranked sum tests with a p-value of <0.05 deemed to be statistically significant.
Results:
There is a statistically significant decrease in the number of units PRBCs used in WB patients compared to component therapy. There is also a statistically significant decrease in the cost of PRBCs when price is controlled. FFP, platelet, and cryoprecipitate use showed an absolute decrease in units used (Table 1), but did not yield statistical significance. Total cost is decreased from 16.79 cost units to 11.70 in whole blood recipients as well (p=0.1660).
Conclusion:
Red blood cell use and cost is decreased when adding whole blood to component therapy for trauma resuscitation. Utilizing whole blood decreases absolute total cost as well as absolute cost of FFP, platelets, and cryoprecipitate. A larger, prospective study is needed to increase the subject size and determine additional statistical significance.
