Abstract
BACKGROUND: There is evidence in the civilian population that resuscitation using group O low titer whole blood (WB) may provide survival benefits to traumatically injured patients. However, there is limited information in the literature concerning the use of WB in non-trauma patients requiring resuscitation. The outcome of patients presenting with non-traumatic hemorrhage who received WB resuscitation was investigated. STUDY DESIGN AND METHODS: Existing data of all adults ≥18 years old who received WB transfusion either as massive transfusion or emergency release blood transfusion at our institution were reviewed from April 2018 to December 2024. Non-trauma patients were stratified into three indication categories (GI bleed, nonoperative hemorrhage, and operative hemorrhage). The primary outcome measure was mortality at 24 h. RESULTS: A total of 331 non-trauma patients received WB in our cohort. The overall 24-h mortality rate was 18.7%, whereas the overall in-hospital 30-day mortality was 46.8%. The most common etiology of non-traumatic hemorrhage was GI bleeding (43.8%, n = 145/331). Nonoperative 24-h mortality was statistically higher than other indication categories. The ICU length of stay and number of WB units transfused was also statistically higher for the operative category. Three patients experienced one allergic and two delayed hemolytic transfusion reactions. DISCUSSION: This study demonstrates that the use of WB in non-trauma patients is associated with a decreased 24 h in-hospital mortality with either operative or GI bleed when compared to nonoperative WB transfusion. Emergent severely hemorrhaging non-trauma patients can receive WB transfusions safely without any increased transfusion related adverse effects.