Whole Blood–Based Resuscitation and Mortality in Patients with Traumatic Intracranial Hemorrhage

BACKGROUND: Traumatic intracranial hemorrhage (tICH) is a major driver responsible for traumatic brain injury-related deaths. Studies have demonstrated an associated survival benefit with plasma administration among patients with tICH. The administration of whole blood (WB), from which plasma is derived, may provide similar or greater benefits. We hypothesize that WB, compared with plasma-based resuscitation, is associated with reduced 30-day mortality among patients presenting with tICH. STUDY DESIGN: This cohort study used the American College of Surgeons-TQIP databank from January 1, 2020, to December 31, 2021, and included adult trauma patients with tICH presenting to Level I and Level II US and Canadian civilian trauma centers. We compared WB resuscitation to plasma-based resuscitation within 4 hours of emergency department arrival. The primary outcome was mortality at 30 days. RESULTS: Among 9,175 patients analyzed, 1,238 (14%) received WB and 7,937 (86%) received plasma-based resuscitation. The overall 30-day mortality was 43%. WB was associated with reduced mortality at 30 days, demonstrating an unadjusted 30% lower risk of mortality (hazard ratio 0.70, 95% CI 0.63 to 0.77, p < 0.001) and a 24% lower risk of 30-day mortality after adjusting for confounders (hazard ratio 0.76, 95% CI 0.58 to 0.98, p = 0.04). CONCLUSIONS: In this cohort study, resuscitation with whole blood was associated with lower 30-day mortality compared with plasma-based resuscitation among patients presenting with tICH. These findings highlight WB as a promising therapeutic strategy for tICH, underscoring the need for future prospective studies to validate its clinical effectiveness.