Intent Versus Execution: Failure to Achieve Balanced Resuscitation in Bleeding Trauma Patients
Authors' conclusion
In this prospective multi-institutional study, <50% of patients were resuscitated in a balanced fashion. The use of WB was associated with an increased likelihood of achieving balanced ratios. Unbalanced resuscitation was associated with decreased survival.
Study context
- Population
- Injured patients requiring both blood transfusions and hemorrhage control procedures; patients dying in the first 60 minutes excludedof 1047 eligible
- Participants
- 1,034 patients
- Exposure
- Achievement of 1:1 ratios at 4 hours vs not; Whole blood (WB) use vs no WB
- Outcome
- Ratios of RBC:FFP and RBC:PLT
- Follow-up
- 4 hours
Methodological detailsmulticentre, observational, 7 academic level-1 trauma centres
- Multicentre
- Observational
- 7 academic level-1 trauma centres
Main finding
As reported in the abstract
Achievement of 1:1 ratios
1:1 RBC:FFP achieved
40%
1:1 RBC:PLT achieved
23%
Observational data: associations, not effects.
Further findings
28-day mortality by achievement of 1:1 RBC:FFP at 4 hours
| Values | OR (95% CI) | P value | ||
|---|---|---|---|---|
| Achievement of 1:1 ratios of RBC:FFPMultivariate regression | achieved 1:1 for RBC:FFP 9% · not achieved 1:1 for RBC:FFP 22% | 0.42 (0.25–0.68) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
28-day mortality by achievement of 1:1 RBC:PLT at 4 hours
| Values | OR (95% CI) | P value | ||
|---|---|---|---|---|
| Achievement of 1:1 ratios of RBC:PLTMultivariate regression | achieved 1:1 for RBC:PLT 13% · not achieved 1:1 for RBC:PLT 18% | 0.61 (0.37–0.98) | P = 0.044 | |
| 0.20.5125Odds ratio (log scale) |
Achieving 1:1 ratios with whole blood (WB) use · 4 hours
| OR (95% CI) | P value | ||
|---|---|---|---|
| WBAchieving RBC:FFP of 1:1 | 2.8 (2.14–3.62) | P < 0.001 | |
| WBAchieving RBC:PLT of 1:1 | 3.4 (2.55–4.62) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
- 28-day mortality by achievement of 1:1 RBC:FFP at 4 hours: unadjusted difference P <0.05
- 28-day mortality by achievement of 1:1 RBC:PLT at 4 hours: unadjusted difference P <0.05
Original publication
Intent Versus Execution: Failure to Achieve Balanced Resuscitation in Bleeding Trauma Patients. Ann Surg. Published 17 June 2025. doi:10.
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