Impact of Whole Blood Resuscitation on Infection Risk in Trauma Patients Undergoing Hemorrhage Control Laparotomy

<b><i>Background:</i></b> There has been a renewed interest in the use of whole blood (WB) in trauma resuscitation, with studies showing improved mortality rate with WB. However, there is a paucity of studies assessing the impact of WB on infectious complications. The aim of this study was to assess the impact of WB during trauma resuscitation on infectious complications. <b><i>Methods:</i></b> A retrospective cohort study utilizing the National Trauma Databank of patients who underwent hemorrhage control laparotomy within one hour was performed. The primary outcome was the impact of receiving WB during trauma resuscitation on surgical infections. Secondary outcome included analysis of a dose-response relation between units of WB and infection. Subgroup analysis was performed on patients undergoing massive transfusion. Multi-variable logistic regression was performed to evaluate outcomes. <b><i>Results:</i></b> A total of 2,151 patients received WB compared with 10,641 patients who did not. Receiving WB was not associated with increased odds of infection (odds ratio [OR] = 1.12, 95% confidence interval [95% CI]: 0.94-1.32, p = 0.22). However, each unit of WB received was associated with a 4% increase in odds of infection (OR = 1.04, 95% CI: 1.00-1.08, p = 0.04). In the massive transfusion subgroup, receiving WB was not associated with increased risk of infection. <b><i>Conclusions:</i></b> Receiving WB during trauma resuscitation was associated with increased odds of infection in a dose-dependent manner, but not in patients undergoing massive transfusion. Further studies evaluating effects beyond mortality are needed to better evaluate the impact of WB use on trauma patients.