Immediate Trauma Resuscitation with Type O Uncrossmatched Blood: A Two-Year Prospective Experience

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Abstract
From January 1982 through December 1983, 83 severely injured and hypovolemic patients were immediately resuscitated with uncrossmatched packed red cells. Seventy-four patients received 250 units (3.3 units/pt) of Group O red blood cells (TOB), and nine patients received 27 units of typespecific blood (TSB) (3.0 units/pt). Additionally, 53 units of TSB were transfused to the TOB group in the interval between TOB immediate transfusion and the availability of fully crossmatched blood. A total of 880 units (10.6 units/pt) were transfused without instance of transfusion reaction or subsequent crossmatching difficulty. The protocol called for two units of TOB (Rh positive for males, Rh negative for females) to be delivered to the resuscitation area before patient arrival. The decision to transfuse TOB was left to the surgeon in charge and was based on the clinical impression of severe shock. Thirty-eight per cent (31 patients) met the criteria of requiring a 'massive transfusion' (> 10 units within 24 hours). Overall, 28 patients (31%) died, 22 within hours of arrival. No death was attributable to transfusion reaction or blood incompatibility. Complications included one dysrhythmia, six patients developed ARDS (7.2%), and ten patients (12%) had 'DIC' Two patients developed positive hepatitis screens, and there was one clinical case of hepatitis observed. None of the 'DIC' cases were related to incompatible blood transfusion. We conclude that for immediate trauma resuscitation, TOB is safe and TOB has additional advantages over TSB or Type O whole blood transfusion. These include immediate availability, universal application for all recipients, and no risk of transfusing 'high titer' plasma. In addition, TOB use avoids the administrative, clerical, and technical errors possible when TSB is used in these urgent situations, especially those involving multiple patients.

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