Don't break the bank: Description of survivors in high-volume transfusion and utility of transfusion in trauma.

Background: In response to blood shortages, providers face pressure to conserve blood. No metrics exist to calculate transfusion utility. We describe characteristics of survivors after high-volume resuscitation and evaluate transfusion utility in low-volume and high-volume resuscitation.

Methods: A retrospective analysis of 2019 American College of Surgeons Trauma Quality Improvement Program was performed on trauma patients ≥16 years old receiving transfusion within 4 hours of arrival. Patients excluded if they died in the emergency department, were dead on arrival, received <2 units of packed red blood cells, did not receive fresh-frozen plasma, or were missing data. High-volume survivors received more blood than 95% of the surviving population (≥17 U of packed red blood cells). High-volume mortality patients received ≥17 U of packed red blood cells and did not survive to discharge. Characteristics of high-volume survivors were identified by multivariable logistic regression. Utility of transfusion was compared between low-volume (<17 U of packed red blood cells) and high-volume (≥17 U of packed red blood cells) groups by totaling U transfused to yield 1 survivor.

Results: In total, 17,407 patients met study criteria, 12,585 (72%) survived. A total of 5.3% (663/12,585) of survivors were high-volume survivors. In total, 23% (1,112/4,823) of mortalities received ≥17 U of packed red blood cells. Low-volume survivors received a greater proportion of product than high-volume survivors (71% vs 34%, P < .001). Low-volume transfusions better used the blood supply (12.6 vs 130.8 U per survivor, P < .001).

Conclusions: High-volume resuscitation yields few survivors and strains the blood supply. Standardized assessment protocols should identify patients with a favorable survival profile to guide allocation. Units transfused per survivor can be used to monitor the effect that blood-conservation protocols have on transfusion utility.