Whole Blood Requirements in Civilian Trauma Resuscitation: Implications for Blood Inventory Program

Introduction: It is unclear what volume of whole blood (WB) a center may need to maintain an adequate inventory. This study aimed to determine the current WB requirements, using the military concept of WB equivalent (WBE), across different levels of trauma centers. Methods: This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database (2017-2018), including adult (≥16 ys) trauma patients who received massive transfusions. The primary outcome was WBE, which was calculated for each patient as units of WB plus equivalent component product units (1 red blood cell + 1 fresh frozen plasma + 0.2 platelet). Results: A total of 9976 patients were identified. The mean (standard deviation) age was 41 (18), and 77.8% were male. The mean initial shock index was 1.2 (1.1), with the mean (standard deviation) systolic blood pressure of 104 (40) during resuscitation in the emergency department. The median (interquartile range) 24-h packed red blood cell, fresh frozen plasma, platelet, and WB were 12 (8-17), 8 (5-13), 2 (1-3), and 2 (1-3), respectively. The median 24-h WBE transfusion was 10 units, 75% of patients required 14 units or less, and 90% required 17 units or less. There was no difference in terms of median WBE transfusions across different levels of trauma centers (Level I: 10U, Level II: 10U, Level III and lower: 10U, P = 0.126). Conclusions: On a nationwide scale, 75% of patients with massive transfusions received a maximum of 14 WBE units. These findings provide important insights to trauma centers on the volume of WB required to maintain adequate WB inventory to effectively support the successful implementation of future WB programs.