Whole blood use and patient outcomes in critical bleeding: Results from the Australian and New Zealand massive transfusion registry (ANZ-MTR).

Aim: Using Australian and New Zealand (NZ) Massive Transfusion Registry (ANZ-MTR) describe Whole Blood (WB) use in massive transfusion (MT) (>=5 red blood cells (RBC) in any 4 h period) in NZ and compare transfusion requirements, laboratory parameters and patient outcomes for WB recipients (WB-R) with those receiving only RBC units (RBC-R). Method(s): All adult MT recipients between 2011 and 2018, at 4 NZ sites with access to WB, were included in the analysis. Result(s): Three hundred fifteen of 1947 (16.1%) MT recipients received >=1 WB unit. WB was most commonly used in vascular surgery (21%), trauma (17%), gastrointestinal (14%), cardiac surgery (11%). WB-R received a median of 2 (IQR 1, 2) WB units and commenced transfusion sooner relative to time of hospital admission than RBC-R. WB-R received fewer RBC (9 (6,16) vs 10 (7,15), P = 0.013), more fresh frozen plasma (FFP) (6 (2,11) vs 5 (2, 9), p < 0.001) and more recombinant FVIIa (P = 0.02) than RBC-R. There were no differences in fibrinogen concentrate, prothrombin complex or other fresh blood products given. In first 4-h of MT, WB-R had shorter APTT compared to RBC-R (42 (34, 60) vs 47 (36, 71) seconds; P = 0.01). Nadir haemoglobin, platelet count and fibrinogen for the 2 groups were similar. WB-R had higher in-hospital mortality (31.4% vs 25.3%, P = 0.024), but similar ICU length of stay and ventilation time. After adjusting for age, sex, number of RBC and FFP units, clinical context and hospital site there was no significant association between WB use and mortality (adjusted odds ratio WB Plasma Reduced 1.19 (95% CI 0.80-1.78) and WB Leucodepleted 1.42 (95% CI 0.94-2.15)).