Data Café Insights: Whole Blood and PRBC Usage

The 2023 ESO Trauma Index offers a detailed analysis of current trends and benchmarks in trauma care, setting a new standard for improvement and allowing healthcare professionals to get a closer look at the data, understand its impact, and explore best practices for enhancing patient outcomes. Join industry experts and Trauma Index authors this and every third Thursday of the month for the ESO Data Café webinar series, as they provide a more in-depth look into each individual metric of the 2023 ESO Trauma Index. Pulling data from the world’s largest de-identified medical database, the Index’s insights reflect over 968,538 hospital records from 596 hospital systems that took place between January 1st and December 31st of 2022. 

One of the most common causes of preventable deaths in trauma is uncontrolled hemorrhaging and its effects account for nearly 30% of all trauma-related deaths in the U.S. and 40% worldwide. At this month’s Data Café, taking place on March 21st, we’re looking deeper at whole blood and packed red blood cell (PRBC) transfusions in trauma care.   

The 2023 Trauma Index revisits the metric surrounding whole blood and packed red blood cell (PRBC) transfusions for trauma patients with an Early Blood Transfusion Needs Score (EBTNS) greater than five. Focusing on patients with an EBTNS greater than five allows us to eliminate records where no score was calculated. The 2023 Trauma Index found that approximately 8%, or 67,000 trauma patients, had an EBTNS score greater than five with 2% receiving only whole blood, 20% only receiving PRBCs, 3% receiving both, and 75% not receiving a blood transfusion. 

Among those that received whole blood, 98% received it within four hours of hospital arrival, while 2% received it more than four hours later. Out of the trauma patients who received PRBC, 76% received it within four hours of their hospital arrival, marking a significant improvement from last year’s findings (46%).
Recently, more and more research supports the administration of whole blood. Patients who received low titer O+ whole blood in transfusions showed significant improvements in shock index (SI), length of stay (LOS), and in mortality rates. They received fewer PRBCs, fresh frozen plasma (FFP), and platelets across their LOS, while total units and volumes were similar. Patients who received whole blood needed fewer Massive Transfusion Protocol (MTP) activations despite a similar requirement of Critical Administration Threshold (CAT) score of three or higher (CAT3+) upon arrival to a hospital. 

Despite whole blood’s effectiveness, there are challenges in its administration including cost, transportation and storage requirements, short shelf life, and rigorous screening and testing standards. The variability in availability and administration across different healthcare settings also presents obstacles. Establishing protocols to address these challenges is the first step in its most effective and efficient administration. 

What are the key takeaways for establishing best practices?  

As we move forward, it’s important to look at the actionable steps we can take to improve trauma care. Drawing from the 2023 ESO Trauma Index, here are some best practices that aim for better patient outcomes through careful and timely interventions.  

• Rapidly assess blood loss and hemodynamics and continuously monitor for changes to ensure timely whole blood administration within 60 minutes of a traumatic injury.  
• Monitor treatment outcomes for patients in hemorrhagic shock and administer timely transfusions of whole blood or PRBCs. 
• Closely monitor blood product availability during massive transfusions to identify areas of improvement  
• Implement MTP for trauma patients experiencing severe hemorrhage.  
• Early administer tranexamic acid (TXA) within three hours of injury to help reduce mortality in patients with significant bleeding.  
• Implement point-of-care coagulation testing, utilizing rapid coagulation tests, such as thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to guide blood transfusion therapy based on the patient’s specific coagulation profile, while tracking data.  
• Balance resuscitation strategy, often in a 1:1:1 ratio of PRBCs with fresh frozen plasma and platelets.  

Please note: Practices are continually evolving based on ongoing research and advancements in the use of blood in trauma care.  As more research becomes available on the use of whole blood and PRBCs, our understanding of their effect on hemorrhaging grows. 

The full 2023 ESO Trauma Index can be downloaded here. 

Get a breakdown of the 2023 Trauma Index data directly from the authors 

In addition to a deeper look at the powerful insights of the 2023 ESO Trauma Index, the ESO Data Café Webinar series allows healthcare professionals to ask questions that help them to better extract their own data. Webinars are scheduled on the third Thursday of every month from 12-1 p.m. CT.
Register for this month’s Data Café on Whole Blood and Packed Red Blood Cells administration, scheduled for March 21st, to hear directly from the authors.   

Next Month’s ESO Data Café Webinar: Antibiotics and Long Bone Fractures

Join us on April 18th to look behind the research on antibiotic administration time in long bone fractures. Don’t forget that for every webinar you attend, you can earn nursing and registry-specific continuing education contact hours. For more details and/or to register head to the ESO Data Café.