Researchers question automatic transfusion of large amounts of blood to trauma patients

Researchers at St. Michael’s Hospital in Toronto are asking questions about the practice of automatically transfusing large amounts of blood and blood products to trauma patients with major bleeding, which has been standard since U.S. military physicians in Iraq and Afghanistan reported in 2007 that resuscitating primarily with blood was associated with dramatic drops in mortality. Their study, “Effect of a fixed-ratio (1:1:1) transfusion protocol versus laboratory-results-guided transfusion in patients with severe trauma: a randomized feasibility trial,” was published in the Canadian Medical Association Journal. (Since blood banks no longer store whole blood, patients are given equal parts of red blood cells, plasma, and platelets—a formula known as 1:1:1.)

Led by Sandro Rizoli, MD, PhD, trauma director of St. Michael’s, researchers performed the first prospective study comparing blood-based resuscitation vs. conventional resuscitation. Until now, all research studies looking at the effectiveness of 1:1:1 had been retrospective.

Rizoli’s team led a randomized control trial at Sunnybrook Health Sciences Centre in Toronto comparing 1:1:1 and previous standards of care (using saline and-or water while waiting for lab tests). The researchers report higher rates of complications in the former group, with no statistical difference in mortality rates. According to Rizoli, while the study showed no statistical difference between the two practices, it showed more wastage of blood and more respiratory complications on the 1:1:1 patients. There was also evidence that patients who avoid transfusions (or have fewer of them) have fewer complications, faster recoveries, and shorter hospital stays. Read the study abstract.